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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3776

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23363105

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.

07-JUL-10

5. Location of incident.

Country: UNITED STATES

Prov / State: VIRGINIA

6. Date incident was first observed.

07-JUL-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. 2596-147

Product Name: UltraGuard One Spot Flea Egg Larvae Treatment for Cats Kittens

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration 2.9 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2596-126

Product Name: Advanced Care 2 in 1 Flea Tick Cat Spray

  • 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).

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

Female

6. Age (provide a range if necessary )

0.25

7. Weight (provide a range if necessary )

5

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

  • General
    • Symptom - Death
  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Hypothermia

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

No

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

1-23363105- The reporter, a pet owner, indicates his animal has been exposed to two insecticides one containing the active ingredients s-methoprene, and the other containing the active ingredient tetrachlorvinphos. The pet owner indicates he applied the latter product, a topical flea and tick spray, to the animal first followed a short time later by the former, a topical flea drop, the night prior to the initial contact with the registrant. The caller stated his animal, a 12 week 5 pound female domestic long hair cat, the next morning demonstrated signs of vomiting, lethargy, and was cold to the touch. The caller had stated he had rinsed the animal with water alone twice since the signs were encountered. The caller was told that combined use of topical flea and tick products is not advised. Used individually according to label instructions the signs seen would not be expected. The animal should be washed with a non-insecticidal shampoo and brought to the veterinarian promptly for assessment and care. The pet owner spontaneously called back one day later to inform the registrant that the animal had died. The pet owner had bathed the animal but had not brought it to the veterinarian. Registrant supported necropsy was offered to determine the animals cause of death. The pet owner declined and indicated he would bury the animal. No further information is available.


To be determined by Registrant

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

Death

19. Provide supplemental information here