Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-0482
2. Registrant Information.
Registrant Reference Number: PROSAR case: 1-39583974
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.
29-JAN-15
5. Location of incident.
Country: CANADA
Prov / State: NOVA SCOTIA
6. Date incident was first observed.
29-JAN-15
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. 29930
PMRA Submission No.
EPA Registration No.
Product Name: UltraGuard One Spot Flea, Egg/Larvae Treatment for Cats/Kittens
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?
Unknown
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Cat / Chat
3. Breed
Mixed breed
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
7
7. Weight (provide a range if necessary )
10
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Respiratory System
- Symptom - Panting
- Symptom - Difficulty Breathing
12. How long did the symptoms last?
>30 min <=2 hrs / >30 min <=2 h
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
Fully Recovered / Complètement rétabli
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
1-39583974 - The reporter, a pet owner, indicated that her cat was exposed to a spot-on insecticide containing the active ingredient methoprene. The reporter applied the product to her 7-year-old, 10 pound, female cat on the day of initial contact with the registrant and within 20 minutes of product application the cat was panting and having a hard time breathing. The reporter had used the same product 6 months earlier without any issue. The reporter was advised that the product has little to no toxicity in mammals but some animals may have a sensitivity to the product. Veterinary care was recommended for any severe or persistent symptoms. On follow-up call, six days later, the reporter indicated that the cats symptoms resolved in about one hour. No veterinary care was sought. No additional information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here