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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-3631
2. Registrant Information.
Registrant Reference Number: Prosar case 1-16059456
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.
23-APR-085. Location of incident.
Country: CANADA
Prov / State: NOVA SCOTIA
6. Date incident was first observed.
22-APR-08Product 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. 26489 PMRA Submission No. EPA Registration No.
Product Name: Control Pet Care System One Spot for Dogs and Puppies 14 kg and Under
- Active Ingredient(s)
- (S)-METHOPRENE
- PERMETHRIN
7. b) Type of formulation.
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).
The reporter applied the product to his dog the evening of 4/22/08.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
Shih Tzu
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
2.5
7. Weight (provide a range if necessary )
14
lbs
8. Route(s) of exposure
Skin
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
- Skin
- Symptom - Itchy skin
- General
- Symptom - Vocalizing
- Skin
- Symptom - Pain
- General
- Symptom - Edema
- Skin
- Symptom - Blister
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
No
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
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
1-16059456: The reporter called on 4/23/08 to report he had applied a topical flea and tick product containing the active ingredients Methoprene and Permethrin the previous evening to his 2.5 year old female dog. He stated that several hours later she had started scratching at her back and whimpering. The scratching continued throughout the night. At of the time of the call on 4/23, the reporter had tried to wash the application site with a wet cloth and noticed the area had seemed painful and edematous. Per the reporter, the dog had a known allergy to bees. The reporter was advised that some animals can have idiosyncratic reactions or an individual sensitivity to topical flea and tick products, and can develop dermal irritation at the application site. The reporter was advised to bathe the dog with lukewarm water and a non-insecticidal shampoo for 15 minutes, and to take the dog to a veterinarian for evaluation. The recommendation was also made to avoid pyrethrin/pyrethroid based topical products in the future. A follow-up call on 4/29/08 revealed the dog had been seen by a veterinarian, who had shaved the area of application. That area had then blistered. A recommendation was made to discuss medication for the area with the attending veterinarian.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
