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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4966

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16332965

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.

27-JUN-08

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH DAKOTA

6. Date incident was first observed.

09-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. 2596-139

Product Name: 3 in 1 Reflecting Control Collar for Dogs

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration 1,02 %
    • TETRACHLORVINPHOS
      • Guarantee/concentration 14,55 %

7. b) Type of formulation.

Other (specify)

Treated Collar

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 about 3 weeks prior to the call (estimated 6/6/08).

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

Mixed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

29

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • General
    • Symptom - Abnormal behaviour
    • Specify - "extra happy"
  • Renal System
    • Symptom - Lack of control of urination
  • Nervous and Muscular Systems
    • Symptom - Ataxia
  • 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?

Yes

14. b) How long was the animal hospitalized?

5

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

1-16332965: The reporter called on 6/27/08 to report the application of a flea and tick collar containing the active ingredients Tetrachlorvinphos and Methoprene to her 7 year old male dog approximately 3 weeks previously. According to the reporter, the dog had become ¿¿¿extra-happy¿¿¿ shortly after the collar had been applied. About 10 days after application, the dog had become incontinent. Then on 6/23, the reporter had found the dog ataxic. He had been taken to a veterinarian and had remained there ever since with no change in symptoms. During the 6/27 call, the potential use of atropine as well as the company sponsored cholinesterase testing program were discussed. A recommendation was made to have the attending veterinarian call regarding treatment and organophosphate testing. A follow-up call revealed the dog had passed away on 6/27.


To be determined by Registrant

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

Death

19. Provide supplemental information here