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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4192

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-16508347

Registrant Name (Full Legal Name no abbreviations): The Hartz Mountain Company

Address: 4 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.

11-AUG-08

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

06-AUG-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. 2724-401-2596

Product Name: UltraGuard Plus Flea and Tick Home Spray

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .01 %
    • PERMETHRIN
      • Guarantee/concentration .28 %

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 reported applied a spray labeled for home use to his 4 year old, 80lb dog on 8/5/2008.

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

Mixed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

80

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Bizarre behaviour
    • Symptom - Difficulty walking
  • Gastrointestinal System
    • Symptom - Drooling
  • General
    • 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?

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

1-16508347: The reporter called on 8/11/2008, to report exposure of his dog to a spray flea and tick product for home use, containing the active ingredients Permethrin and Methoprene. According to the reporter, on 8/5/2008 he sprayed the product on the dog not realizing that this product was designated for use in the home, not on animals. On 8/6/2008, the reporter noticed the dog standing in the corner of the yard ┐┐┐staring at a bush┐┐┐ not moving. Once the dog started to move he stumbled. On 8/7/2008 the dog began salivating. On 8/8/2008, the dog experienced increased salivation. And the dog experienced difficulty walking. At this point, the owners realized that the product was not for animal use and they bathed the dog to remove the product. From 8/8/2008 to 8/10/2008, the dog continued to get worse and was presented to a Veterinarian on 8/10/2008 and examined. The dog┐┐┐s temperature was normal. Per the reporter, the Veterinarian did not believe there was a problem with the dog. The dog was sent home with a prescription of Cephalexin. The reported administered the Cephalexin to the dog every 6 hours. The reporter also attempted to hydrate the dog by squirting water in its mouth via syringe; however the dog would not ingest the water. On 8/11/2008, the dog died.


To be determined by Registrant

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

Death

19. Provide supplemental information here