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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7749

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15110228

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.

16-JUL-07

5. Location of incident.

Country: UNITED STATES

Prov / State: KANSAS

6. Date incident was first observed.

09-JUL-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 Home Spray: EPA 2724-401-2596

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .01 %
    • PERMETHRIN
      • Guarantee/concentration .28 %

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Res. - In Home / Rés. - à l'int. maison

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

Exotic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

12

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Seizure
    • Symptom - Fasciculations
  • Gastrointestinal System
    • Symptom - Bloody vomit

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?

Other / Autre

specify Unknown exposure route

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

History: Caller states she used spray on living room carpet and upholstery one week ago on July 9. Within two hours of use her 2 yo male cat was dead. Symptoms prior to death were tremors, hematemeis, and seizures. Pet buried on the owner's farm. She has a second exotic cat that is in the hospital: The hospitalized animal was tremoring. She also has other animals in the house and they are not exhibiting any symptoms. Caller states the cats could have rolled in product once it was sprayed. She has used Frontline in the past and has had no issues. Assessment: This product has a low level of toxicity and wide margin of safety. Symptoms described are not an expected reaction under normal use of product. 07/19/2007 Follow-Up She's is sure male cat rolled in the area of application as she could smell it on his fur while he was having symptoms prior to death. (name) came home yesterday and is doing well. DVM is unsure of cause for symptoms.


To be determined by Registrant

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

Death

19. Provide supplemental information here