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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7779

2. Registrant Information.

Registrant Reference Number: Prosar Case 1-15358313

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.


5. Location of incident.


Prov / State: TEXAS

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. EPA 2596-140

Product Name: Hartz Control Flea and Tick Spray for Dogs - EPA 2596-140

  • Active Ingredient(s)
      • Guarantee/concentration .07 %
      • Guarantee/concentration 1.08 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


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?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Pit Bull Terrier

4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


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


  • Gastrointestinal System
    • Symptom - Diarrhea
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Weight loss
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


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 has 13 wk old dog who she applied product to Saturday 9/22/07. Dog has been having persistent diarrhea (which she states does not smell like Parvo) and is acting lethargic. Caller states he has lost significant weight since Saturday. Caller states she cannot afford a Veterinarian so she has been "putting fluids" in him after every time he has the diarrhea. Caller states she was reading the package and it says the product can cause these symptoms. States dog had "7 in 1" puppy shot about 2 weeks ago. Assessment: Not an expected reaction to product . Since symptoms have persisted and dog is losing weight, recommend dog be seen by Veterinarian immediately for evaluation and treatment. Explained Hartz testing policy. Gave case # to give to Veterinarian to contact us for instructions on submitting blood sample. 10/02/07 Follow-Up Spoke to Owners mother. A puppy died last week but she does not know which dog it was as she has more than one and this lady wants nothing to do with her dogs. She thinks daughter said it died of Parvo but does not think it was taken to the Veterinarian for diagnosis or treatment.

To be determined by Registrant

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


19. Provide supplemental information here