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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3767

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-22942927

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.

08-JUN-10

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

04-JUN-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).

The product was applied to an animal three times within a 30 day time frame, technique unknown

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

Bloodhound

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

76

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 - Salivating excessively
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
  • General
    • Symptom - Fever
    • 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?

1

Day(s) / Jour(s)

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

1-22942927- The reporter, a pet owner, calls to report his animal was exposed to an insecticide containing the active ingredient Tetrachlorvinphos. The animal, a 2 year male 76 pound Bloodhound, had the product applied three times over the past 30 days (unspecified technique or interval). One day following the most recent application (three days prior to the initial contact with the registrant) the pet owner indicated they observed signs of salivation, tremors and a 108 degree temperature in their animal. The animals signs persisted for one day and the pet owner sought veterinary care. The animal was hospitalized and supportive care consisting of intravenous fluid therapy and administration of muscle relaxants was described. The animal was held in hospital for one day until its death. The caller was advised that the signs and out come seen in his animal would not be expected following routine labeled usage. The caller was advised the animal may have had an underlying medical condition that contributed to its demise. The caller was informed of registrant supported necropsy program. The pet owner┐s veterinarian had contacted the registrant to gather further information about the necropsy program and indicated the animal would be submitted. It is unknown if there was follow through on the necropsy. No further information is known.


To be determined by Registrant

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

Death

19. Provide supplemental information here