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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-2672

2. Registrant Information.

Registrant Reference Number: 2020-CA-000348

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.

01-OCT-20

5. Location of incident.

Country: CANADA

Prov / State: NOVA SCOTIA

6. Date incident was first observed.

01-OCT-20

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 Cat Flea and Tick Spray Spray

  • Active Ingredient(s)
    • TETRACHLORVINPHOS
      • Guarantee/concentration 1.08 %

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).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic (Unspecified)

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.30

7. Weight (provide a range if necessary )

2.27

kg

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

  • General
    • Symptom - Hiding
  • Gastrointestinal System
    • Symptom - Foaming at mouth
  • Nervous and Muscular Systems
    • Symptom -
    • Specify - Limp body

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

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

On 01-Oct-2020, a 0.30 year old, approximately 2.27 kilogram, intact, male, Domestic (Unspecified) cat, in unknown condition, with no known concomitant medical conditions, was administered 1 spray of Hartz UltraGuard Cat Flea and Tick Spray (Tetrachlorvinphos) via the topical route by the animal owner. Approximately 30 minutes later, the cat was found hiding in the closet and was exhibiting foaming at the mouth and his body was limp. The animal owner then rinsed the cat with water and wiped its mouth and the symptoms continued. Recommended oral dilution of food and water, during consultation. The cat willingly ate his food and drank water and his symptoms significantly improved but continued. Recommended continuing to monitor the cat at home and seek veterinary evaluation if the symptoms persisted and/or if any new symptoms developed. No further information was received in this case.


To be determined by Registrant

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

Minor

19. Provide supplemental information here

The information contained in this report is based on self-reported statements provided to the registrant during telephone interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and cannot form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.