Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-3649
2. Registrant Information.
Registrant Reference Number: Prosar case 1-16120237
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.
08-MAY-08
5. Location of incident.
Country: UNITED STATES
Prov / State: PENNSYLVANIA
6. Date incident was first observed.
08-MAY-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. 2596-151
Product Name: UltraGuard Flea and Tick Drops for Dogs and Puppies over 60 lbs
- Active Ingredient(s)
- 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 product was applied incorrectly to the pet on 5/7/08 - 2 tubes were used instead of 1 tube.
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
German Shephard
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
5
7. Weight (provide a range if necessary )
120
lbs
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
- Respiratory System
- Symptom - Respiratory distress
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?
Unknown
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
1-16120237: The reporter called on 5/8/08 to report the misapplication of a topical flea and tick product containing the active ingredient Phenothrin to his 5 year old male dog. Two tubes of the product had accidentally been applied the previous day instead of one. By the time of the call, the dog had become very lethargic with partial anorexia. A recommendation was made to bathe the dog in mild dish soap and to seek veterinary care if the symptoms persisted or worsened. A follow-up call was placed on 5/14. When the reporter called back on 5/16, it was revealed that the dog had been bathed but then had begun to experience respiratory distress within the hour. He had been taken to an emergency veterinary clinic and placed on oxygen, but had soon passed away. A post-mortem examination plus radiographs had been performed but nothing significant had been found.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here