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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3769

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-23052491

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.

16-JUN-10

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

16-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. 25922      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Flea TIck Drops for Dogs Puppies Over 30 lbs

  • 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).

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

Cat / Chat

3. Breed

Domestic long hair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

8

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
    • Symptom - Muscle weakness
  • Respiratory System
    • Symptom - Rapid breathing
    • Symptom - Abnormal lung sounds

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

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

1-23052491- The reporter, a veterinary technician, calls to report an animal has been exposed to a pesticide containing the active ingredient Permethrin. The caller indicates the animal¿s owner had applied the topical flea and tick drops to her 2 year 8 pound female domestic long hair cat the day prior to the initial contact with the registrant. The pet owner realized shortly after application of the product that it was not labeled for use in cats. She reported as soon as she had realized her mistake she promptly washed the animal with a non insecticidal shampoo. The caller reports a day later the animal was demonstrating signs of muscle tremors, weakness, rapid breathing and stridorous breathing. The caller was informed that the symptoms were consistent with inappropriate use of canine products with this active ingredient on feline patients. The caller was advised decontamination as done was appropriate and may be repeated. The caller was, further, advised of symptomatic and supportive care that could be administered. On routine call back it was revealed the animal was bathed, given intravenous fluids, and released to its owner. The duration of symptoms was not clarified. No further information is known.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here