Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2017-5206
2. Registrant Information.
Registrant Reference Number: ProPharma Group case:# 1-49237380
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.
04-AUG-17
5. Location of incident.
Country: UNITED STATES
Prov / State: PENNSYLVANIA
6. Date incident was first observed.
04-AUG-17
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: HARTZ ULTRA GUARD FLEA &TICK POWDER FOR CATS
- Active Ingredient(s)
- TETRACHLORVINPHOS
- Guarantee/concentration 3.3 %
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).
1-49237380 - The product is not intended for use on cats less than 12 weeks of age, but was applied to kittens that were 4.5 weeks of age.
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
Domestic Shorthair
4. Number of animals affected
4
5. Sex
Unknown
6. Age (provide a range if necessary )
0.08
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 - Death
- Symptom - Lethargy
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
1-49237380 - The reporter, a pet owner, indicated his cats were exposed to an insecticidal powder containing the active ingredient tetrachlorvinphos. One day before the day of initial contact with the registrant, the reporter indicated he applied the product to four 4.5-week-old, domestic shorthair cats of unknown genders and weights. At the time of initial contact, the three kittens were lethargic and had stopped nursing. The reporter was advised that the product is not intended to be used on kittens that are so young, and the kittens should be bathed immediately and seek veterinary evaluation. The reporter was not available on follow-up call three days later. On follow-up call four days later, the reporter indicated he had not sought veterinary care for the kittens and they had all died. 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