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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-4701

2. Registrant Information.

Registrant Reference Number: Prosar 1-20046836

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.

18-SEP-09

5. Location of incident.

Country: UNITED STATES

Prov / State: KENTUCKY

6. Date incident was first observed.

17-SEP-09

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. 2596-63

Product Name: 2 in 1 Flea/Tick Collar for Cats

  • Active Ingredient(s)
    • TETRACHLORVINPHOS
      • Guarantee/concentration 14.55 %

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).

The collar was applied to the cat on 09/16/2009.

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

Male

6. Age (provide a range if necessary )

Unknown

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

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

11. List all symptoms

System

  • Skin
    • Symptom - Other
    • Specify - "Covered in thousands of fleas"
    • Symptom - Bleeding
  • Respiratory System
    • Symptom - Panting
  • General
    • Symptom - Hiding
  • Respiratory System
    • Symptom - Difficulty Breathing
  • Gastrointestinal System
    • Symptom - Abnormal tongue colour
    • Specify - "Tongue turned pale white"
  • General
    • Symptom - Death

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

1-20046836: A reporter (cat owner) called on 09/18/2009 to report the exposure of his cat to a flea and tick collar containing the active ingredient Tetrachlorvinphos. According to the reporter, the cat showed up as a stray several years ago and had been cared for by the reporter since that time. The reporter was unable to provide an age of the cat. Initially, the reporter stated that the cat was 4-6 years old, and then later stated that the cat may be 10 years old or older. The cat's health history was also unknown. The reporter's other cats had fleas, but the reporter said that this cat did not have any fleas when the collar was placed on 09/16/2009. On 09/17/2009, the cat had "thousands of fleas", was bleeding from flea bites, and panting. The reporter rinsed the cat with water. The cat was trying to hide, but the reporter placed it on a bed. The cat developed difficulty breathing, his tongue turned "pale white", and he died on 09/17/2009. The reporter was advised that adverse effects from routine use of the product are not anticipated. The reporter was also advised that the signs described may be from another cause or from the heavy flea infestation. A recommendation was made to consider necropsy to determine the cause of death. No further information was obtained.


To be determined by Registrant

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

Death

19. Provide supplemental information here