Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7760

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15162525

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.

30-JUL-07

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

23-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 2 in 1 Flea + Tick Killer for Dogs - EPA 2596-94

  • Active Ingredient(s)
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Guarantee/concentration .2 %
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration .12 %
    • PYRETHRINS
      • Guarantee/concentration .06 %

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?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Golden Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

6

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

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Anorexia
    • Symptom - Weight loss
    • Symptom - Tongue swelling
  • Respiratory System
    • Symptom - Difficulty Breathing
  • 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 states she put the product onto her dog last Monday (7/23/07). The caller states she applied a little extra to the dog because he was bigger and he had a thick haircoat. Caller states that on Tuesday night the dog stopped eating. On Tuesday evening (7/24/07) she attempted to feed the dog a steak, but he wasn't interested. On Wednesday (7/25/07) he started vomiting, and vomited fairly consistently until Thursday evening (7/26/07). The only food she was able to get into the dog was a small amount of yogurt. The dog was still drinking water. Caller noticed that the dog's tongue was swollen on Friday, and the dog was having difficulty breathing. Caller also stated that the dog lost a significant amount of weight over the course of the week. Caller states she called in here on Friday, and H+S told her to bathe the dog with human shampoo and take it in to the vet (I could not find any record of her calling here). Caller states she did give the dog a bath, but couldn't afford the vet care. The dog died at about 1AM on Sat morning, and is already buried.


To be determined by Registrant

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

Death

19. Provide supplemental information here