Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-4260
2. Registrant Information.
Registrant Reference Number: Prosar 1-19306657
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-JUL-09
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
27-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. 26490
PMRA Submission No.
EPA Registration No.
Product Name: UltraGuard Plus Flea\Tick Drops for Dogs\Puppies Over 30 lbs (Canada)
- 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 product was applied the evening prior to the call (7\26\09).
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
Female
6. Age (provide a range if necessary )
5
7. Weight (provide a range if necessary )
50
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Anorexia
- Symptom - Vomiting
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
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
Fully Recovered / Complètement rétabli
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
1-19306657: The reporter, an animal owner, called on 7\27\09 to report the exposure of her 5 year old dog to a flea and tick topical product containing the active ingredients Permethrin and Methoprene. According to the reporter, the product had been applied to the dog the previous evening. The dog had vomited the morning of 7\27, which was characterized by the reporter as being a "green\yellow color". The reporter stated that the dog also did not want to eat treats\drink water. The safety profile of the product was discussed, a recommendation was made to replace any fluid deficit, and the reporter was encouraged to seek veterinary care if the dog's symptoms persisted or worsened. A follow-up call was placed on 7\29\09, at which time it was revealed that the dog's symptoms had resolved after about two days. It is unknown if the dog was seen by a veterinarian.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here