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: 2008-3205

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16213915

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-MAY-08

5. Location of incident.

Country: UNITED STATES

Prov / State: SOUTH CAROLINA

6. Date incident was first observed.

Unknown

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. 2724-777-2596

Product Name: InControl Flea and Tick Carpet Powder 16 oz.

  • Active Ingredient(s)
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration .5 %
    • PYRETHRINS
      • Guarantee/concentration .075 %

7. b) Type of formulation.

Dust

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).

The reporter applied the product sometime the beginning of the week of 5/30/08. In addition to the listed active ingredients, the product also contains Linalool (2.5%) and Nylar: 2-(1-methyl-2-(4-phenoxyphenoxy)ethoxy) Pyridine (0.2%, a registered trademark of McLaughlin Gormley King).

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

Pit Bull Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.25

7. Weight (provide a range if necessary )

7

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Vomiting
  • 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?

Other / Autre

specify No witnessed exposure. Unknown how or even if the pet was exposed to the product.

17. Provide any additional details about the incident

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

1-16213915: The reporter called on 5/30/08 to report her dog had passed away several days after she had used a flea and tick treatment for carpeting. The product contained the active ingredients Linalool, Piperonyl Butoxide, Pyrethrins, and Nylar (2-(1-methyl-2-(4-phenoxyphenoxy)ethoxy) Pyridine). According to the reporter, the product had been applied at the beginning of the week. She stated her dog had been very ill for 3 days, and that he had developed watery diarrhea, vomiting, and lethargy. The caller inquired about and was given information about the safety profile of the product. A recommendation was made to replace lost fluids and seek veterinary care. A follow-up call on 6/6 revealed the dog had passed away. He had become anorexic and had passed on 5/31. The reporter had not brought him into a veterinarian. As the dog had already been buried, the company sponsored necropsy was declined.


To be determined by Registrant

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

Death

19. Provide supplemental information here