Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-4221
2. Registrant Information.
Registrant Reference Number: Prosar case 1-16330715
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.
26-JUN-08
5. Location of incident.
Country: UNITED STATES
Prov / State: TENNESSEE
6. Date incident was first observed.
24-JUN-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 (non-specific)
- 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 to the pet on 6/23/08.
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
Miniature Poodle
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
7
7. Weight (provide a range if necessary )
7
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Gastrointestinal System
- Symptom - Vomiting
- Symptom - Oral hemorrhage
- Specify - blood in sides of mouth
- Respiratory System
- Symptom - Difficulty Breathing
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
1-16330715: The reporter called on 6/26/08 to report the sudden death of her 7 year old dog after the application of a topical flea and tick product containing the active ingredient Phenothrin. According to the reporter, she had applied the product the evening of 6/23. By 6 A.M. the next morning, the dog had developed seizure-like activity. It had also developed symptoms of vomiting, had blood in the sides of its mouth, and had developed breathing difficulties. The reporter had taken the dog to a veterinarian, but the clinic had not yet opened for the day. The dog had passed away while the reporter had been waiting for the clinic to open. It was discussed that sudden death was not an expected reaction to the product. The company sponsored necropsy program was also talked about during the 6/26 call, but the dog had already been buried.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here