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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5438

2. Registrant Information.

Registrant Reference Number: Prosar 1-20863000

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.

30-NOV-09

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

29-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.       PMRA Submission No.       EPA Registration No. 2596-151

Product Name: UltraGuard Flea/Tick Drops for Dogs/Puppies Over 60 lbs

  • Active Ingredient(s)
    • 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 11/29/2009.

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

Unknown breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.58

7. Weight (provide a range if necessary )

60

lbs

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Anorexia
  • General
    • Symptom - Adipsia
  • Gastrointestinal System
    • Symptom - Rectal hemorrhage
  • General
    • Symptom - Lethargy
    • Symptom - Death

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

1-20863000: A reporter (dog owner) called on 11/30/2009 to report the exposure of her dog to a flea and tick product containing the active ingredient Phenothrin. According to the reporter, the product was applied to the dog on 11/29/2009. The dog may have licked the product after application. Within 30 minutes, the dog started vomiting which persisted to the time of the report. He was also unable to eat or drink. The reporter was advised that the product is not expected to result in the signs described following routine use. Minor gastrointestinal signs may occur if the product is ingested. A recommendation was made to bathe the dog in a non-insecticidal shampoo or hand dish soap. The reporter was advised to have the dog evaluated by a veterinarian if the signs persist. On follow up on 12/01/2009, the reporter stated that the dog now has blood coming from its rectum, is very lethargic, and is still vomiting and anorexic. The reporter was again advised that the signs are not expected with product use. The reporter was advised that the dog needs to be seen immediately by a veterinarian for evaluation and treatment. On follow up, the reporter stated that the dog died in the car on 12/01/2009 en route to the veterinarian. 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