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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-4694

2. Registrant Information.

Registrant Reference Number: Prosar 1-19828953

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.

08-SEP-09

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

06-SEP-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. 8376      PMRA Submission No.       EPA Registration No.

Product Name: 2 in 1 Lustre Bath for Cats (Canada)

  • Active Ingredient(s)
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • PIPERONYL BUTOXIDE
    • PYRETHRINS

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 to the cat on 09/06/2009.

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

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

12

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Vocalizing
  • Gastrointestinal System
    • Symptom - Constipation
    • Specify - trying to use litter box but nothing is coming out
    • Symptom - Anorexia
  • General
    • Symptom - Dehydration
  • Renal System
    • Symptom - Low urine output
    • Specify - trying to use litter box but nothing is coming out

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Yes

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

1-19828953: A reporter (cat owner) called on 09/08/2009 to report her cat's exposure to a flea and tick shampoo containing the active ingredients Pyrethrins, NOBD, and Piperonyl Butoxide. According to the reporter, the product was used to bathe the cat on 09/06/2009. A few hours following the bath, the cat started vomiting. At the time of the report, the cat was still vomiting and vocalizing as if he was in pain. The reporter also noted that the cat did not appear to be urinating or defecating, and that he was anorexic. The reporter was advised that the signs described are not expected with use of the product. Small ingestions of the product may result in minor, transient gastrointestinal irritation. A recommendation was made to bathe the cat in hand dish soap and have the cat evaluated by a veterinarian to assess the persistent signs. On follow up, the reporter stated that the cat was seen by a veterinarian. The cat was dehydrated and treated with IV fluids and anti-emetics. Blood work had not been run. The cat was still vomiting at the time of the follow up, and the reporter planned to take the cat back to the veterinarian for evaluation. No further information was obtained.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here