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Sécurité des produits de consommation

Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2010-3899

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: PROSAR Case # 1-23524506

Nom du titulaire (nom légal complet, aucune abbréviation): The Hartz Mountain Corporation

Adresse: 400 Plaza Drive

Ville: Secaucus

État: New Jersey

Pays: USA

Code postal /Zip: 07094-3688

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.

Incident chez un animal domestique

4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

21-JUL-10

5. Lieu de l'incident.

Pays: UNITED STATES

État: LOUISIANA

6. Date de la première observation de l'incident.

30-JUN-10

Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation. 2596-86

Nom du produit: UltraGuard Flea Tick Dip for Dogs Cats Concentrate

  • Matière active
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Garantie/concentration 1.11 %
    • PIPERONYL BUTOXIDE
      • Garantie/concentration .67 %
    • PYRETHRINS
      • Garantie/concentration .33 %

7. b) Type de formulation.

Liquide

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?

Oui

9. Dose d'application.

Inconnu

10. Site d'application (choisir tout ce qui s'applique).

Site: Animal / Usage sur un animal domestique

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?

Inconnu

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cat / Chat

3. Race

Domestic shorthair

4. Nombre d'animaux touchés

1

5. Sexe:

Femme

6. Âge (fournir un ordre de grandeur si nécessaire)

3

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Cutanée

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

>8 hrs <=24 hrs / > 8 h < = 24 h

11. Énumérer tous les symptômes

Système

  • General
    • Symptôme - Lethargie
  • Système gastro-intestinal
    • Symptôme - Incontinence fécale
  • Peau
    • Symptôme - Décoloration
    • Specify - bright yellow
  • General
    • Symptôme - Déshydratation
    • Symptôme - Mort
  • Système rénal
    • Symptôme - Incontinence urinaire

12. Quelle a été la durée des symptômes?

Persisted until death

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Non

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Non

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Mort

16. De quelle manière l'animal a-t-il été exposé?

Treatment / Traitement

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-23524506- The reporter, a pet owner, indicates exposure of several animals to an insecticide containing the active ingredients pyrethrins, Piperonyl butoxide, and N-octyl bicycloheptene dicarboximide. The caller reports she has used the product per the label instructions on a total of 14 cats and one dog. She indicates she applied the product to the animals on 06/30/10. She reports three cats (Subform III, #2), all one year domestic shorthair cats, began to cough within one hour of use. Their symptoms persisted for "a few weeks". She reports the dog (Subform III, #3), a one and one half year female mixed breed dog, developed dermal redness immediately following product use and generalized dermal hives by the next day. She reports she used a topical product provided by a family member (unspecified) on the animal and its signs resolve within "a few weeks". One cat (Subform III, #1), a three year female domestic shorthair, was reported to have died within four days of application. The pet owner reported within 24 hours of application the animal developed the signs of lethargy, urinary, and fecal incontinence. Within another two days the animal developed bright yellow skin and dehydration. The animal was dead by the next morning. The caller, lastly, adds that two additional cats (subform III, #4), four month male domestic shorthair cats, have developed dermatologic signs described as "skin and fur rolling off of their back legs" one week following the application of the product. She does not indicate if these symptoms are persistent. All other animals remained asymptomatic at the point of the call. The caller had not brought the animals to the veterinarian at any point during the described events. No necropsy has been performed. The caller was advised both the symptoms and outcome described would be unexpected following exposure to these active ingredients and the use of this product. Necropsy would be helpful at determining the cause of death of the animal that had passed. She indicated it had been buried. Lastly veterinary care would be recommended to assist in both diagnosis and humane care of the animals. No further information is available.


À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Mort

19. Donner des renseignements additionnels ici

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cat / Chat

3. Race

domestic shorthair

4. Nombre d'animaux touchés

3

5. Sexe:

Inconnu

6. Âge (fournir un ordre de grandeur si nécessaire)

1

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Cutanée

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

>30 min <=2 hrs / >30 min <=2 h

11. Énumérer tous les symptômes

Système

  • Système respiratoire
    • Symptôme - Toux

12. Quelle a été la durée des symptômes?

>1 wk <=1 mo / > 1 sem < = 1 mois

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Non

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Non

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Fully Recovered / Complètement rétabli

16. De quelle manière l'animal a-t-il été exposé?

Treatment / Traitement

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-23524506- The reporter, a pet owner, indicates exposure of several animals to an insecticide containing the active ingredients pyrethrins, Piperonyl butoxide, and N-octyl bicycloheptene dicarboximide. The caller reports she has used the product per the label instructions on a total of 14 cats and one dog. She indicates she applied the product to the animals on 06/30/10. She reports three cats (Subform III, #2), all one year domestic shorthair cats, began to cough within one hour of use. Their symptoms persisted for "a few weeks". She reports the dog (Subform III, #3), a one and one half year female mixed breed dog, developed dermal redness immediately following product use and generalized dermal hives by the next day. She reports she used a topical product provided by a family member (unspecified) on the animal and its signs resolve within "a few weeks". One cat (Subform III, #1), a three year female domestic shorthair, was reported to have died within four days of application. The pet owner reported within 24 hours of application the animal developed the signs of lethargy, urinary, and fecal incontinence. Within another two days the animal developed bright yellow skin and dehydration. The animal was dead by the next morning. The caller, lastly, adds that two additional cats (subform III, #4), four month male domestic shorthair cats, have developed dermatologic signs described as "skin and fur rolling off of their back legs" one week following the application of the product. She does not indicate if these symptoms are persistent. All other animals remained asymptomatic at the point of the call. The caller had not brought the animals to the veterinarian at any point during the described events. No necropsy has been performed. The caller was advised both the symptoms and outcome described would be unexpected following exposure to these active ingredients and the use of this product. Necropsy would be helpful at determining the cause of death of the animal that had passed. She indicated it had been buried. Lastly veterinary care would be recommended to assist in both diagnosis and humane care of the animals. No further information is available.


À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Mineure

19. Donner des renseignements additionnels ici

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Dog / Chien

3. Race

mixed breed

4. Nombre d'animaux touchés

1

5. Sexe:

Femme

6. Âge (fournir un ordre de grandeur si nécessaire)

1.5

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Cutanée

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

<=30 min / <=30 min

11. Énumérer tous les symptômes

Système

  • Peau
    • Symptôme - Érythème
    • Symptôme - Urticaire

12. Quelle a été la durée des symptômes?

>1 wk <=1 mo / > 1 sem < = 1 mois

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Non

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Non

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Fully Recovered / Complètement rétabli

16. De quelle manière l'animal a-t-il été exposé?

Treatment / Traitement

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-23524506- The reporter, a pet owner, indicates exposure of several animals to an insecticide containing the active ingredients pyrethrins, Piperonyl butoxide, and N-octyl bicycloheptene dicarboximide. The caller reports she has used the product per the label instructions on a total of 14 cats and one dog. She indicates she applied the product to the animals on 06/30/10. She reports three cats (Subform III, #2), all one year domestic shorthair cats, began to cough within one hour of use. Their symptoms persisted for "a few weeks". She reports the dog (Subform III, #3), a one and one half year female mixed breed dog, developed dermal redness immediately following product use and generalized dermal hives by the next day. She reports she used a topical product provided by a family member (unspecified) on the animal and its signs resolve within "a few weeks". One cat (Subform III, #1), a three year female domestic shorthair, was reported to have died within four days of application. The pet owner reported within 24 hours of application the animal developed the signs of lethargy, urinary, and fecal incontinence. Within another two days the animal developed bright yellow skin and dehydration. The animal was dead by the next morning. The caller, lastly, adds that two additional cats (subform III, #4), four month male domestic shorthair cats, have developed dermatologic signs described as "skin and fur rolling off of their back legs" one week following the application of the product. She does not indicate if these symptoms are persistent. All other animals remained asymptomatic at the point of the call. The caller had not brought the animals to the veterinarian at any point during the described events. No necropsy has been performed. The caller was advised both the symptoms and outcome described would be unexpected following exposure to these active ingredients and the use of this product. Necropsy would be helpful at determining the cause of death of the animal that had passed. She indicated it had been buried. Lastly veterinary care would be recommended to assist in both diagnosis and humane care of the animals. No further information is available.


À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Modérée

19. Donner des renseignements additionnels ici

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cat / Chat

3. Race

unknown

4. Nombre d'animaux touchés

2

5. Sexe:

Homme

6. Âge (fournir un ordre de grandeur si nécessaire)

0.33

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Cutanée

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

>1 wk <=1 mo / > 1 sem < = 1 mois

11. Énumérer tous les symptômes

Système

  • Peau
    • Symptôme - Peau pelée
    • Symptôme - Perte de cheveux

12. Quelle a été la durée des symptômes?

Unknown / Inconnu

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Non

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Non

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Unknown/Inconnu

16. De quelle manière l'animal a-t-il été exposé?

Treatment / Traitement

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-23524506- The reporter, a pet owner, indicates exposure of several animals to an insecticide containing the active ingredients pyrethrins, Piperonyl butoxide, and N-octyl bicycloheptene dicarboximide. The caller reports she has used the product per the label instructions on a total of 14 cats and one dog. She indicates she applied the product to the animals on 06/30/10. She reports three cats (Subform III, #2), all one year domestic shorthair cats, began to cough within one hour of use. Their symptoms persisted for "a few weeks". She reports the dog (Subform III, #3), a one and one half year female mixed breed dog, developed dermal redness immediately following product use and generalized dermal hives by the next day. She reports she used a topical product provided by a family member (unspecified) on the animal and its signs resolve within "a few weeks". One cat (Subform III, #1), a three year female domestic shorthair, was reported to have died within four days of application. The pet owner reported within 24 hours of application the animal developed the signs of lethargy, urinary, and fecal incontinence. Within another two days the animal developed bright yellow skin and dehydration. The animal was dead by the next morning. The caller, lastly, adds that two additional cats (subform III, #4), four month male domestic shorthair cats, have developed dermatologic signs described as "skin and fur rolling off of their back legs" one week following the application of the product. She does not indicate if these symptoms are persistent. All other animals remained asymptomatic at the point of the call. The caller had not brought the animals to the veterinarian at any point during the described events. No necropsy has been performed. The caller was advised both the symptoms and outcome described would be unexpected following exposure to these active ingredients and the use of this product. Necropsy would be helpful at determining the cause of death of the animal that had passed. She indicated it had been buried. Lastly veterinary care would be recommended to assist in both diagnosis and humane care of the animals. No further information is available.


À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Mineure

19. Donner des renseignements additionnels ici