Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-6265
2. Registrant Information.
Registrant Reference Number: ProPharma Group case:# 1-45495825
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.
06-SEP-16
5. Location of incident.
Country: UNITED STATES
Prov / State: MAINE
6. Date incident was first observed.
05-SEP-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.
PMRA Submission No.
EPA Registration No. 2596-147
Product Name: HARTZ ULTRA ONESPOT GUARD FLEA EGG & FLEA LARVAE TREATMENT FOR CATS
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration 2.9 %
7. b) Type of formulation.
Liquid
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 Longhair
4. Number of animals affected
3
5. Sex
Unknown
6. Age (provide a range if necessary )
0.25
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>8 hrs <= 24 hrs / >8 h <= 24 h
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
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
1-45495825 - The reporter, a pet owner, indicated his cats were exposed to an insecticidal spot-on product containing the active ingredient (S)-methoprene. Two days before the day of initial contact with the registrant, the reporter applied a single dose of the product to each of his three 13-week-old, domestic longhaired kittens of unknown gender and weight. Within twenty-four hours all three of the kittens had died. The kittens did not receive any veterinary care for the incident, nor had they been to a veterinarian before the incident. The reporter was provided information about necropsy to study the cause of 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