Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-3928
2. Registrant Information.
Registrant Reference Number: Prosar 1-19073836
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.
06-JUL-09
5. Location of incident.
Country: UNITED STATES
Prov / State: TEXAS
6. Date incident was first observed.
04-JUL-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. 2596-150
Product Name: UltraGuard Plus Flea/Tick Drops Plus for Dogs/Puppies Over 60 lbs
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration 2.3 %
- 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 dog on 07/01/2009.
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
Boxer
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
2
7. Weight (provide a range if necessary )
80
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
- Nervous and Muscular Systems
- Nervous and Muscular Systems
- Symptom - Difficulty walking
- Symptom - Difficulty getting up
- Specify - "Unable to stand"
- Symptom - Ataxia
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
1-19073836: A reporter (dog owner) called on 07/06/2009 to report the exposure of her dog to a topical flea and tick product containing the active ingredients Phenothrin and Methoprene. According to the reporter, the product was applied to the dog on 07/01/2009 prior to being taken to a pet sitter. On 07/04/2009, the pet sitter noticed that the dog was lethargic, ataxic, having trouble standing and walking, and having seizures. The dog died before he could be taken to a veterinarian. The pet sitter was unsure whether the dog had gotten into anything at her house. The reporter was advised that the signs described are not expected with routine product use. Very rarely, an individual reaction may occur but this is expected within 12-24 hours following product application, not 3 days later. A necropsy was recommended to try and determine the cause of death. 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