Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-3633
2. Registrant Information.
Registrant Reference Number: Prosar case 1-16063043
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.
24-APR-08
5. Location of incident.
Country: UNITED STATES
Prov / State: CONNECTICUT
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. 2596-150
Product Name: UltraGuard Pro Flea and Tick Drops Plus for Dogs and Puppies 31-60 lbs
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration 2.3 %
- D-PHENOTHRIN
- Guarantee/concentration 85.7 %
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 caller applied the product to her dogs on a Monday and by Thursday her 2 year female mixed breed dog was anorexic.
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
Mixed breed
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
2
7. Weight (provide a range if necessary )
30
lbs
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 - Anorexia
- Symptom - Constipation
- General
- Symptom - Malaise
- 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?
Yes
14. b) How long was the animal hospitalized?
3
Day(s) / Jour(s)
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
1-16063043: The reporter called on 4/24/08 to report her 2 year female mixed breed dog had passed away sometime after the reporter had applied a topical flea and tick product containing the active ingredients Phenothrin and Methoprene. The reporter stated she had applied the product on a Monday and by Thursday her dog was anorexic. She took the dog to a veterinarian, who hospitalized the dog for 3 days. The reporter stated the dog was constipated during her stay and continued to be anorexic after she was taken home. The dog passed away at home, and the reporter had the attending veterinarian perform a necropsy. According to the reporter, the attending veterinarian felt there was a paralysis of the colonic muscles as well as a "toxin in the dog's blood" secondary to use of the product. The company sponsored necropsy program was discussed with the caller.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here