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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5434

2. Registrant Information.

Registrant Reference Number: Prosar 1-20776691

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.

19-NOV-09

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

18-NOV-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. 25923      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Flea/Tick Drops for Dogs/Puppies Under 30 lbs (Canada)

  • Active Ingredient(s)
    • 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 to the dog on 11/18/2009.

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

Mixed Breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

15

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

  • General
    • Symptom - Hyperactivity
  • Respiratory System
    • Symptom - Panting
  • General
    • Symptom - Hiding
  • Respiratory System
    • Symptom - Tachypnea

12. How long did the symptoms last?

Unknown / Inconnu

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

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

1-20776691: A reporter (dog owner) called on 11/19/2009 to report the exposure of her dog to a flea and tick product containing Permethrin. According to the reporter, the product was applied to the dog on 11/18/2009. Within 2-4 hours, the dog became hyperactive and was panting. The dog was bathed in a non-insecticidal shampoo which did help decrease the signs. The morning of the report, the dog became hyper again, was hiding, and had fast respirations. The reporter was advised that mild overdoses of product may result in signs such as hypersalivation, vomiting, drooling, mild tremors, and hyperexcitability or depression. Some products result in a transient paraesthesia, a temporary tingling sensation. Severe overdoses result in hyper- or hypothermia, dyspnea, disorientation, muscle weakness, severe tremors, and seizures. The reporter was advised that bathing is the appropriate first step. A recommendation was made to have the dog evaluated by a veterinarian to determine the cause of her persistent signs. Several attempts at follow up were unsuccessful. No further information was obtained.


To be determined by Registrant

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

Minor

19. Provide supplemental information here