Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-5628
2. Registrant Information.
Registrant Reference Number: ProPharma Group case:# 1-45251067
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-AUG-16
5. Location of incident.
Country: CANADA
Prov / State: NEWFOUNDLAND
6. Date incident was first observed.
16-AUG-16
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: HARTZ ULTRAGUARD FLEA & TICK SPRAY FOR CATS
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
Female
6. Age (provide a range if necessary )
0.25
7. Weight (provide a range if necessary )
1
lbs
8. Route(s) of exposure
Skin
Eye
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
12. How long did the symptoms last?
<=30 min / <=30 min
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
1-45251067 - The reporter, a pet owner, indicated his cat was exposed to an insecticidal spray containing the active ingredient tetrachlorvinphos. On the day of initial contact with the registrant, the reporter applied the product to his 1-pound, 3-month-old, female, domestic shorthair cat and accidently got some in her eyes. An unknown amount of time after application, the cat started holding her eyes closed. The reporter indicated he rinsed the cats eyes out for a few minutes and she seems OK now. The reporter was advised that there should not be any lasting effects from the exposure. 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