Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2017-7111
2. Registrant Information.
Registrant Reference Number: ProPharma Group case:# 1-49947728
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-OCT-17
5. Location of incident.
Country: UNITED STATES
Prov / State: MASSACHUSETTS
6. Date incident was first observed.
03-OCT-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 %
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 2596-139
Product Name: HARTZ ULTRAGUARD PLUS FLEA & TICK COLLAR FOR CATS&KITTENS
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration 1.02 %
- TETRACHLORVINPHOS
- Guarantee/concentration 14.55 %
7. b) Type of formulation.
Dust
Other (specify)
collar
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).
1-49947728 - The reporter was advised that no more than one topical flea and tick product should be applied to a cat at one time. The reporter was also advised that application of flea and tick products should be discussed with a veterinarian before applying to a geriatric cat (18 years 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
Unknown
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
18
7. Weight (provide a range if necessary )
12
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
- Nervous and Muscular Systems
- Symptom - Collapse
- Symptom - Seizure
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
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
1-49947728 - The reporter, a pet owner, indicated his cat was exposed to insecticidal powder and collar containing the active ingredients tetrachlorvinphos and (S)-methoprene. One day before the day of initial contact with the registrant, the reporter applied the powder product on his 12-pound, 18-year-old, female cat of unknown breed. Within 30 seconds, the cat collapsed, but seemed to recover one hour later. On the day of initial contact, the reporter applied more powder to the cat and also applied the collar. The cat had a seizure and died an unknown amount of time later. The reporter declined necropsy. 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