Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2923

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-22680413

Registrant Name (Full Legal Name no abbreviations): The Hartz Mountain Corporation

Address: 400 Plaza Drive

City: Secaucus

Prov / State: NJ

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-MAY-10

5. Location of incident.

Country: UNITED STATES

Prov / State: WISCONSIN

6. Date incident was first observed.

14-MAY-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. 2596-125

Product Name: UltraGuard Flea Tick Spray for Dogs

  • Active Ingredient(s)
    • TETRACHLORVINPHOS
      • Guarantee/concentration 1.08 %

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).

Product was applied to an animal. No detail is available about method

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

Schnauzer

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1.5

7. Weight (provide a range if necessary )

14.6

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
  • General
    • Symptom - Lethargy
  • Respiratory System
    • Symptom - Shortness of breath
  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Hypothermia
    • Symptom - Weakness
    • Symptom - Death

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?

Yes

14. b) How long was the animal hospitalized?

Unknown

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

1-22680413- The reporter, a veterinarian, calls to report exposure of a patient to an insecticidal product containing the active ingredient Tetrachlorvinphos. The owner of the 18 month 14 pound Miniature Schnauzer dog had applied the product to the animal on either 05/13 or 05/14/10, the caller was unsure. Details about application were not available. 24 hours after application the animal developed vomiting, diarrhea, weakness, lethargy and anorexia. The animal did not present to the veterinarian until 05/17/10. The veterinarian reports at that point the animal had, further, developed hypothermia and shortness of breath. The veterinarian hospitalized the animal and initiated intravenous fluid therapy, atropine (route not specified), and performed radiographs which were reported to be within normal limits. The animal was reported to have died on transport to the local emergency clinic for after hours management. The caller was informed the signs observed would not be expected following use of the product as labeled. Necropsy was offered through the University of Illinois Veterinary Diagnostic Laboratory to determine etiology. It is unknown if the Veterinarian pursued the necropsy.


To be determined by Registrant

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

Death

19. Provide supplemental information here