Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-1589
2. Registrant Information.
Registrant Reference Number: Prosar case 1-15996815
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.
09-APR-08
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
09-APR-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. 26489
PMRA Submission No.
EPA Registration No.
Product Name: Control Pet Care System One Spot for Dogs and Puppies 14kg and Under
- Active Ingredient(s)
- (S)-METHOPRENE
- PERMETHRIN
7. b) Type of formulation.
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 reporter applied the product to his dog on 4/8/08.
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
Dachshund
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
15
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Nervous and Muscular Systems
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
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
1-15996815: The reporter called on 4/9/08 to report his 1 year male dog started shaking its head sometime after the reporter applied a topical flea and tick product containing the active ingredient Methoprene and Permethrin. The product was applied 4/8/08 and sometime during the night the dog began to shake its head. The reporter stated that the dog was now consistently shaking its head but was otherwise normal. He was wondering if the symptom was related to using the product. The safety profile of the product was discussed. It was recommended that, if the reporter was at all concerned, the dog should be bathed in mild, non-insecticidal shampoo to remove the product. Advice was also given regarding keeping the dog warm after the bath until it dried, and to seek veterinary care if the symptom continued. A follow-up call on 4/11 was attempted several times but no contact could be established as the given phone number was incorrect.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here