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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-0619

2. Registrant Information.

Registrant Reference Number: Prosar 1-17060260

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.

Human

Domestic Animal

4. Date registrant was first informed of the incident.

09-DEC-08

5. Location of incident.

Country: UNITED STATES

Prov / State: MAINE

6. Date incident was first observed.

09-DEC-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: UltraGuard Plus Flea/Tick Spray for Dogs 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: Res. - In Home / Rés. - à l'int. maison

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 carpet and the dog's bedding on 12/08/2008.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

  • Nervous and Muscular Systems
    • Symptom - Headache

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Other

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

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

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-17060260: A reporter called on 12/09/2008 to report the exposure of herself and a hamster to a flea and tick spray containing the active ingredients Tetrachlorvinphos and Methoprene. According to the reporter, the product was applied to the carpet and the dog's bedding on 12/08/2008. The hamster was in the room where the product was sprayed. The hamster (1st Subform III) was found dead on 12/09/2008. No signs were noted prior to the hamster's death. The reporter wondered if the product could be responsible for the hamster's death. The reported (1st Subform II) also mentioned that she developed a headache on 12/09/2008 and wondered if she had inhaled the product. The reporter was advised that the hamster's death is not expected following use of the product. The reporter was also informed that studies conducted in rodents have shown them to be very tolerant of the active ingredients. The reporter was advised that individuals who find an odor strong or unpleasant may develop general symptoms such as nausea, headache, and respiratory irritation. The reporter was also advised that these symptoms are generally self-limiting and resolve with removal of the odor. A recommendation was made to ventilate the treated area by opening windows and running fans. The reporter was also advised that treated surfaces could be washed with an appropriate household cleaner if necessary. The reporter was advised to call back with any further questions or concerns. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Other / Autre

specify Rodent

3. Breed

Teddy Bear Hamster

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Death

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?

Other / Autre

specify Unknown

17. Provide any additional details about the incident

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

1-17060260: A reporter called on 12/09/2008 to report the exposure of herself and a hamster to a flea and tick spray containing the active ingredients Tetrachlorvinphos and Methoprene. According to the reporter, the product was applied to the carpet and the dog's bedding on 12/08/2008. The hamster was in the room where the product was sprayed. The hamster (1st Subform III) was found dead on 12/09/2008. No signs were noted prior to the hamster's death. The reporter wondered if the product could be responsible for the hamster's death. The reported (1st Subform II) also mentioned that she developed a headache on 12/09/2008 and wondered if she had inhaled the product. The reporter was advised that the hamster's death is not expected following use of the product. The reporter was also informed that studies conducted in rodents have shown them to be very tolerant of the active ingredients. The reporter was advised that individuals who find an odor strong or unpleasant may develop general symptoms such as nausea, headache, and respiratory irritation. The reporter was also advised that these symptoms are generally self-limiting and resolve with removal of the odor. A recommendation was made to ventilate the treated area by opening windows and running fans. The reporter was also advised that treated surfaces could be washed with an appropriate household cleaner if necessary. The reporter was advised to call back with any further questions or concerns. No further information was obtained.


To be determined by Registrant

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

Death

19. Provide supplemental information here