Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-3632
2. Registrant Information.
Registrant Reference Number: Prosar case 1-16055272
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.
22-APR-08
5. Location of incident.
Country: UNITED STATES
Prov / State: CALIFORNIA
6. Date incident was first observed.
20-APR-08
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. 2596-149
Product Name: Advanced Care 3 in 1 Foaming Shampoo (non-specific)
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .101 %
- D-CIS, TRANS ALLETHRIN
- Guarantee/concentration .109 %
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).
The reporter applied the product to her two 4 week old puppies 2 days prior to the call. The product was used against labelled directions (labelled for 12 weeks and older).
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
Unknown
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
0.08
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
Unknown / Inconnu
11. List all symptoms
System
- General
- Symptom - Parvovirus infection
- Specify - Diagnosed with Parvovirus
- Symptom - Death
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
Unknown
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
1-16055272: The reporter called on 4/22/08 to report that one of her two 4 week old puppies had died and the other had only been given a 50/50 chance of survival. She had accidentally used a flea and tick shampoo against label directions (labelled for 12 weeks and older) 2 days prior to the call. The product contained the active ingredients d-trans Allethrin and (S)-Methoprene. According to the reporter, she had taken the 2 puppies in to her veterinarian, who had diagnosed them with Parvovirus. The female puppy had subsequently died and the male puppy had been given a 50/50 survival prognosis. The label directions were explained during the call, as was the fact that the product did not cause or contribute to the puppy's infection with Parvovirus.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Unknown
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.08
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
Unknown / Inconnu
11. List all symptoms
System
- General
- Symptom - Parvovirus infection
- Specify - Diagnosed with Parvovirus
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?
Unknown
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
1-16055272: The reporter called on 4/22/08 to report that one of her two 4 week old puppies had died and the other had only been given a 50/50 chance of survival. She had accidentally used a flea and tick shampoo against label directions (labelled for 12 weeks and older) 2 days prior to the call. The product contained the active ingredients d-trans Allethrin and (S)-Methoprene. According to the reporter, she had taken the 2 puppies in to her veterinarian, who had diagnosed them with Parvovirus. The female puppy had subsequently died and the male puppy had been given a 50/50 survival prognosis. The label directions were explained during the call, as was the fact that the product did not cause or contribute to the puppy's infection with Parvovirus.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Major
19. Provide supplemental information here