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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4174

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16437244

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-JUL-08

5. Location of incident.

Country: UNITED STATES

Prov / State: MAINE

6. Date incident was first observed.

22-JUL-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. 2596-140

Product Name: Advanced Care 3 in 1 Dog Spray 16 fl oz

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .07 %
    • TETRACHLORVINPHOS
      • Guarantee/concentration 1.08 %

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 on 7/22/08 to the reporter's 21 month old dog, a therapy dog in training.

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

Labrador Retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1.75

7. Weight (provide a range if necessary )

95

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Seizure
  • General
    • Symptom - Vocalizing
    • Symptom - Death
    • Symptom - Abnormal behaviour
    • Specify - rolled

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?

Treatment / Traitement

17. Provide any additional details about the incident

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

1-16437244: The reporter called on 7/23/08 to report the death of her 21 month old male dog about 1 hour after the application of a topical flea and tick product containing the active ingredients Tetrachlorvinphos and Methoprene. According to the reporter, the product had been applied outside the afternoon of 7/22. After product application the dog had shaken himself off and rolled. He had then gone inside the house and had lain down, yipping every once in a while. Some time later the dog had suddenly screamed and had then had a seizure. He had passed away in spite of an attempt at CPR by the reporter and a friend. The reporter inquired about and was given information regarding the registrant┐s case review and reimbursement process. Note: the dog was a therapy dog in training.


To be determined by Registrant

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

Death

19. Provide supplemental information here