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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7739

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15064150

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.

02-JUL-07

5. Location of incident.

Country: UNITED STATES

Prov / State: ILLINOIS

6. Date incident was first observed.

29-JUN-07

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.

Product Name: Advanced Care 3 in 1 Flea + Tick Collar for Cats - EPA: 2596-139

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Unknown
    • TETRACHLORVINPHOS
      • Unknown

7. b) Type of formulation.

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).

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 Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

10

lbs

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

  • General
    • Symptom - Death
  • Respiratory System
    • Symptom - Shortness of breath
  • Nervous and Muscular Systems
    • Symptom - Difficulty walking
  • General
    • Symptom - Vocalizing
  • Nervous and Muscular Systems
    • Symptom - Shaking
    • Symptom - Agitation

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?

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

Product was applied to his cat on Friday, 6/29. Became concerned immediately when he activated it and the dust went over the cat. Around 1 am Saturday morning cat started having problems, appeared to be convulsing (shaking), problems walking, and problems breathing. Also she was very agitated and crying. States that after speaking to a friend and then contacting an animal Emergency clinic he was advised to remove the collar and then bathe her. This was done and she started to improve Saturday. Sunday morning cat was not looking good again, laid down on the floor and died. Cat was not taken to a DVM at anytime. Did have fleas, denies use of any other products on cat or in home over the past 1 week. State he knows this caused the death since it could be the only possible cause. Cat is still at home in a box. Planning to take her to the DVM within the next 1 hour. CS mentioned Necropsy, is interested in this as long as he does not have to pay.


To be determined by Registrant

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

Death

19. Provide supplemental information here