Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-2723
2. Registrant Information.
Registrant Reference Number: Prosar 1-18935482
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.
24-JUN-09
5. Location of incident.
Country: UNITED STATES
Prov / State: ALABAMA
6. Date incident was first observed.
16-JUN-09
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/Tick Drops for Dogs/Puppies 31-60 lbs
- 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 25-pound puppy on 06/14/2009. NOTE: This product is not labeled for use on dogs weighing less than 31 pounds.
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
Labrador Retriever
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.33
7. Weight (provide a range if necessary )
25
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Vomiting
- Symptom - Anorexia
- Symptom - Difficulty swallowing
- Specify - "Trying to drink but unable to. Acts like something is lodged in his throat."
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
1-18935482: A reporter (puppy owner) called on 06/24/2009 to report the exposure of her puppy to a flea and tick product containing the active ingredient Phenothrin. According to the reporter, a partial tube of product intended for dogs weighing 31-60 pounds was applied to the 25-pound puppy on 06/14/2009. On 06/16/2009, the puppy was not eating and was vomiting. On 06/18/2009, the puppy was still vomiting and was acting is if it wanted to drink but something was lodged in its throat. The reporter inspected the dog's throat and did not see anything unusual. The puppy died on 06/19/2009. It was never evaluated by a veterinarian. The reporter was advised that the product is not intended for dogs weighing less than 31 pounds. The reporter was also advised that the active ingredient is generally well-tolerated and even with the inappropriate product use, the signs described would not be expected. The reporter was advised to consider necropsy to try and determine the cause of death. The reporter stated that the dog had been buried. No further information was obtained. NOTE: The product is labeled for use on dogs weighing 31-60 pounds.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here