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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-6268

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-42134533

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.

09-OCT-15

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

08-OCT-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. 25655      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Flea/Tick Spray for Cats

  • Active Ingredient(s)
    • TETRACHLORVINPHOS

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

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

4

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

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Vocalizing
  • Nervous and Muscular Systems
    • Symptom - Fasciculations
  • 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

1-42134533 - The reporter, a pet owner, indicated that her cat was exposed to a spray containing the active ingredient tetrachlorvinphos. One day prior to initial contact with the registrant the pet owner bathed her 4-year-old, male, 10 pound domestic shorthaired cat with a non-insecticidal shampoo and then sprayed him with the registrant product to treat an active flea infestation. Within three hours of product application the cat was vocalizing, twitching and not eating. The reporter thought the symptoms were secondary to the cats flea infestation so she did not seek veterinary care. The following day the reporter found her cat dead. The reporter indicated that the cat did have an open wound where it had been chewing and licking because of the fleas and she was concerned that he may have absorbed the spray through the open wound. The reporter was advised that there are numerous possible causes for sudden death in a cat and a necropsy was recommended to help determine the underlying cause for her cats death. No additional information is available.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here