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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7754

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15129284

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.

20-JUL-07

5. Location of incident.

Country: UNITED STATES

Prov / State: LOUISIANA

6. Date incident was first observed.

01-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 Flea + Tick Spray for Dogs - EPA 2596-140

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration ,07 %
    • TETRACHLORVINPHOS
      • Guarantee/concentration 1,08 %

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: 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

Dog / Chien

3. Breed

Chihuahua

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.67

7. Weight (provide a range if necessary )

3

lbs

8. Route(s) of exposure

Skin

Oral

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

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
    • Symptom - Salivating excessively
    • Symptom - Anorexia
  • 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

History: Caller sprayed the product for the first time on his 8 month 3# Male Chihuahua named "Clifford" on 7-1-07. He and his family noticed 2 days later, 7-3-07 the puppy was vomiting and had diarrhea. Symptoms lasted for 3-4 days, then resolved. Denies any other products used or applied to him. On Sunday, 7-15-07 he sprayed the puppy again with the spray and later on Monday, 7-16-07 he and his family noticed that the puppy was salivating from licking his hair, began vomiting, not wanting to eat and developed diarrhea. The Symptoms progressed until Tuesday, 7-17-07 and became worse and he was going to take the puppy to the Veterinarian when he got home that afternoon and "Clifford" had passed away. He spoke with "other people and a Veterinarian" and they mentioned parvovirus, coronavirus, unknown virus, parasites, etc. The puppy was buried in the yard that Tuesday, 7-17-07. Assessment: Discussed with the caller the AI is Tetrachlorvinphos which is an OP. Discussed with the caller the symptoms of SLUDGE and CNS symptoms. Some of the symptoms as reported and described fit the profile of the AI, but some do not, along with the time frame involved from the time of the exposure to the length of the symptoms. Unknown as to what may have caused the puppy's death as the puppy has been buried for the last 4 days.


To be determined by Registrant

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

Death

19. Provide supplemental information here