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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-5723
2. Registrant Information.
Registrant Reference Number: PROSAR Case #: 1-32032454
Registrant Name (Full Legal Name no abbreviations): The Hartz Mountain Corporation
Address: 400 Plaza Drive
City: Secaucus
Prov / State: New Jersey
Country: USA
Postal Code: 07094-3688
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
10-NOV-125. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
10-NOV-12Product Description
7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.
Active(s)PMRA Registration No. 25922 PMRA Submission No. EPA Registration No. Unknown
Product Name: Ultraguard Flea and Tick Drops for Dogs and Puppies over 30 lbs
- Active Ingredient(s)
- (S)-METHOPRENE
- PERMETHRIN
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
Site: Animal / Usage sur un animal domestique
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
No
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Domestic Shorthair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
1.5
7. Weight (provide a range if necessary )
11
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Muscle tremors
- Symptom - Fasciculations
- Symptom - Muscle twitching
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
16. How was the animal exposed?
Treatment / Traitement
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-32032454 - The reporter, a pet owner, indicated her animal was exposed to an insecticide containing the active ingredients methoprene and permethrin. The pet owner indicated she had applied the topical flea preventative to her 1.5 year old female domestic shorthair cat on the day of initial contact with the registrant. The reporter realized that this product was intended to be used on dogs only after application. The cat was bathed with dish soap. The cat developed symptoms of twitching/muscle tremors. The pet owner was advised the product was not labeled for use on this species. The pet owner was advised of proper decontamination and to seek immediate veterinary care. On follow up two days later, the owner reported that the cat had been taken to the veterinarian and was treated. The cat was still twitching/having muscle fasciculations, and the owner was planning to return to the veterinarian for follow up treatment. No further follow up was obtained. No additional information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
