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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2014-0497
2. Registrant Information.
Registrant Reference Number: PROSAR case #: 1-35979036
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.
16-JAN-145. Location of incident.
Country: UNITED STATES
Prov / State: WISCONSIN
6. Date incident was first observed.
Unknown
Product 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. PMRA Submission No. EPA Registration No. 2596-78
Product Name: Ultraguard Flea/Tick Powder for Cats
- Active Ingredient(s)
- TETRACHLORVINPHOS
- Guarantee/concentration 3.3 %
- TETRACHLORVINPHOS
7. b) Type of formulation.
Dust
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
Unknown
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
11
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- General
- Symptom - Lethargy
- Gastrointestinal System
- Symptom - Vomiting
- Symptom - Diarrhea
- Symptom - Anorexia
- General
- Symptom - Death
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
No
14. a) Was the animal hospitalized?
No
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Died
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
1-35979036 - The reporter, a pet owner, indicated that her five cats were exposed to an insecticidal powder containing the active ingredient tetrachlorvinphos. During the initial call the reporter indicated recent application of the product to her 5 cats, she also stated that she had recently bathed her cats with an unknown flea and tick shampoo and applied a non-registrant flea and tick collar with unknown active ingredients to her cats. In addition, she had bombed her house with a non-registrant insecticide. At the time of her initial call the reporter indicated that two weeks after treating her cats all of her cats had hair loss and red spots. The reporter was advised that simultaneous use of multiple insecticides is not recommended as it can result in an overdose and bathing was recommended. On follow-up call, five days later, the reporter stated that eight days earlier (three days prior to her initial call) her 11 year-old, male cat (Subform III #1) had passed away. The reporter had not mentioned this cat during her initial call. Per the reporter prior to death the cat had diarrhea, was vomiting and had been lethargic and vomiting. No veterinary care was sought and the cat passed away at home. During that follow-up call the reporter indicated that her other 4 cats were doing better. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
