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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3867

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-22937343

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: TEXAS

6. Date incident was first observed.

07-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. 2596-151

Product Name: UltraGuard Flea Tick Drops for Dogs Puppies 4-15 lbs

  • Active Ingredient(s)
    • D-PHENOTHRIN
      • Guarantee/concentration 85.7 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2496-149

Product Name: UltraGuard Plus Flea TIck Dog Shampoo with Aloe

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .101 %
    • D-TRANS ALLETHRIN
      • Guarantee/concentration .109 %
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Guarantee/concentration .154 %

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 pet owner applied the flea and tick drops to the animal four days prior to the initial contact with he registrant and washed the animal with the shampoo product two days later

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

Labrador Retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.375

7. Weight (provide a range if necessary )

14

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 - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Weight loss
    • Symptom - Bloody vomit
  • General
    • Symptom - Death
  • Gastrointestinal System
    • Symptom - Gagging

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

1-22937343- The reporter, a pet owner, called to indicate her animal had been exposed to two pesticides, the first containing Phenothrin, the second containing the active ingredients Allethrin and Methoprene. The caller indicated she had applied the products to her 4.5 month 14 pound Labrador retriever dog. The caller was Spanish speaking and while an interpreter was connected with the call the caller hung up. Attempts were made to contact the reporter but a wrong number had been given. One day later the reporter spontaneously called back and clarified the history. She reported she had applied the initial product (a topical flea and tick drop) to her animal five days earlier. The next day the animal started gagging as if it were about to vomit and then went to "stay under the house". The animal continued to look and act very sick (unspecified) and the owner removed the animal from below the house and bathed it with the second product (an insecticidal shampoo). The evening of the initial contact with the registrant the animal died after the owner stated she noted bloody stool and bloody vomitus. The pet owner stated the animal had been buried with no necropsy performed. She had not sought veterinary care at any time during the animal's illness. The pet owner was advised routine use of these products as labeled would not be expected to elicit the signs seen. Further, even in overdosage situations with the associated active ingredients due to abuse or inappropriate usage the signs seen would not be expected. It was added that it was quite likely the animal had some underlying unrecognized illness or unrelated exposure that may reveal itself in 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