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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5454

2. Registrant Information.

Registrant Reference Number: Prosar 1-16689231

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.

29-SEP-08

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

22-SEP-08

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. 2724-401-2596

Product Name: UltraGuard Plus Flea/Tick Home Spray 22 fl oz

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .01 %
    • PERMETHRIN
      • Guarantee/concentration .28 %

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 home spray was mistakenly purchased instead of the dog spray. The product was sprayed on the dog an unknown number of times starting 3 weeks prior to the report. The last time the product was applied to the dog was on 09/18/2008.

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

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 )

5

7. Weight (provide a range if necessary )

8

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

10. Time between exposure and onset of symptoms

>1 wk <=1 mo / > 1 sem < = 1 mois

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Anorexia
    • Symptom - Diarrhea
  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Shaking
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

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

1-16689231: A reporter called on 09/29/2008 to report the exposure of a dog to a flea and tick home spray containing the active ingredients Methoprene and Permethrin. According to the reporter, she accidentally bought the home spray thinking it was for use on dogs. She started applying the product to her dog about three weeks prior to the report. The product was applied to the dog an unknown number of times prior to the final application on 09/18/2008. On 09/22/2008, the dog began vomiting, having diarrhea, not eating, and shaking. The dog died on 09/26/2008. It is unclear based on the report whether the dog was evaluated by a veterinarian. The reporter was advised that the dog's signs may have been related to the unintentional misuse of the product or the signs may have been secondary to another cause. No further information was obtained. NOTE: This product is intended for use in the home, not directly on pets.


To be determined by Registrant

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

Death

19. Provide supplemental information here