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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-4704

2. Registrant Information.

Registrant Reference Number: Prosar 1-20111231

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.

22-SEP-09

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

Unknown

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. 2596-153

Product Name: UltraGuard Rid Flea/Tick Shampoo with Oatmeal for Dogs 18 fl oz

  • Active Ingredient(s)
    • D-PHENOTHRIN
      • Guarantee/concentration .27 %

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 used to bathe the dog on 3-4 occasions in the 2 weeks prior to the report. NOTE: This product is labeled to be used weekly. A company carpet powder had also been applied to the home, but the dog never had any exposure to the product.

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Mixed breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

10

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

Unknown / Inconnu

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Seizure
  • Blood
    • Symptom - Hypoglycemia
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

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

1-20111231: A reporter (veterinary clinic employee) called on 09/22/2009 to report the exposure of a dog to a flea and tick shampoo containing the active ingredient Phenothrin. According to the reporter, the dog was bathed with the product 3-4 times within the 2 weeks prior to the report. A company carpet powder had also been applied to the home, but the reporter indicated that the dog did not have an exposure to that product. The dog had a seizure the morning of the report. The last time the product was used was unknown. The reporter was advised that the active ingredient in the product is present in a very low percentage and would not be expected to result in the adverse effects from an overdose. The reporter was also advised that signs of pyrethrin overdose develop within 30 minutes to 12 hours following exposure. The signs of pyrethrin toxicity were discussed. A recommendation was made to bathe the dog in a hand dish soap, and to treat symptomatically. Treatment may include Phenobarbital for seizures and monitoring of body temperature. On follow up on 09/23/2009, the reporter stated that the dog's blood work showed hypoglycemia. The dog was doing well, had not had any more seizures and was sent home on 09/22/2009. On follow up on 09/25/2009, a veterinary clinic employee stated that the dog died. A necropsy was not planned, and there was no further information on the case. NOTE: This product is labeled for weekly use.


To be determined by Registrant

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

Death

19. Provide supplemental information here