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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-0872

2. Registrant Information.

Registrant Reference Number: Prosar 1-21125535

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.

21-DEC-09

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

21-DEC-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. 25922      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Flea/TIck Drops for Dogs/Puppies Over 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 a rat on 12/21/2009. NOTE: This product is not labeled for use on rats.

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

Other / Autre

specify Rodent

3. Breed

Rat

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

0.5

lbs

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Shaking
    • Symptom - Seizure
  • Gastrointestinal System
    • Symptom - Anorexia
  • Eye
    • Symptom - Other
    • Specify - Eyes closed
  • Cardiovascular System
    • Symptom - Cardiac arrest
  • 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?

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

1-21125535: A reporter (rat owner) called on 12/21/2009 to report the exposure of her rat to a canine flea and tick product containing the active ingredient Permethrin. According to the reporter, several drops of product were applied to the rat 1 hour prior to the report. At the time of the report, the rat was shaking, having a seizure, not eating, and its eyes were closed. The reporter was advised that the product is not labeled for use on rats. A recommendation was made to thoroughly bathe the rat with hand dish soap and room temperature water. The reporter was advised to take the rat to the veterinarian immediately following bathing. On follow up on 12/22/2009, the reporter stated that the rat was brought to the veterinarian where it went into cardiac arrest and died. No further information was obtained. NOTE: The product is not labeled for use on rats.


To be determined by Registrant

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

Death

19. Provide supplemental information here