Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-1440
2. Registrant Information.
Registrant Reference Number: PROSAR 1-21996462
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-MAR-10
5. Location of incident.
Country: UNITED STATES
Prov / State: OHIO
6. Date incident was first observed.
20-MAR-10
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 03/18/2010 or 03/19/2010.
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
Medical Professional
2. Type of animal affected
Dog / Chien
3. Breed
Labrador Retriever
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
4.5
7. Weight (provide a range if necessary )
94
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
- Gastrointestinal System
- Symptom - Diarrhea
- Symptom - Vomiting
- Eye
- Symptom - Protrusion of the third eyelid
- Nervous and Muscular Systems
- General
- Symptom - Abnormal behaviour
- Specify - "Circling"
- Nervous and Muscular Systems
- Symptom - Difficulty getting up
- Specify - "Cannot stand"
- Renal System
- Symptom - Inappropriate urination
- Specify - "Urinates when pressure is applied to the abdomen"
- Gastrointestinal System
- Symptom - Inappropriate defecation
- Specify - defecates when pressure is applied to the abdomen"
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
1-21996462: A reporter (a veterinarian) called on 03/22/2010 to report the exposure of a dog to a flea and tick product containing the active ingredient Phenothrin. According to the reporter, the product was applied to the dog on 03/18 or 03/19/2010. On 03/20/2010, the dog developed vomiting, diarrhea, a prominent third eyelid, drooling, and lethargy. The dog was evaluated by the reporter on 03/20/2010. The dog was bathed and her symptoms improved immediately. The dog was also treated with Pepcid and subcutaneous fluids. The symptoms recurred on 03/22/2010, and the owner bathed the dog again. The signs resolved for 45 minutes following bathing, but resurfaced again. The dog presented to the reporter on 03/22/2010 with shaking, circling, lethargy, the inability to stand up, and urination and defecation secondary to applying pressure on the abdomen. The reporter was advised that the active ingredient is not one that dogs typically have a sensitivity to. The signs described are not expected following routine use of the product, nor are signs expected several days following product application. The reporter was advised that treatment is symptomatic and supportive, and that there is not an antidote. A recommendation was made to consider other causes for the dog's signs. On follow up, a veterinary clinic employee stated that the dog died on 03/22/2010. 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