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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3868

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23138366

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.

22-JUN-10

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW YORK

6. Date incident was first observed.

21-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. 2596-63

Product Name: Advanced Care 2 in 1 Flea Tick Collar for Cats

  • Active Ingredient(s)
    • TETRACHLORVINPHOS
      • Guarantee/concentration 14.55 %

7. b) Type of formulation.

Other (specify)

collar

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Domestic shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Ataxia
  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Death
  • Respiratory System
    • Symptom - Respiratory distress
    • Symptom - Runny nose
  • Nervous and Muscular Systems
    • Symptom - Seizure

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

1-23138366- The reporter, a veterinary technician, indicates exposure of a patient to a pesticide containing the active ingredient Tetrachlorvinphos. The caller reports a 7 year 10 pound male domestic shorthair cat had the product, a collar, applied 3 days prior to the initial contact with the registrant. After application of the product the animal was not seen again for 24-48 hours by the owner, as the animal is an outdoor cat and did not return home. When the animal did return home the animal was reported to have developed signs of ataxia, anorexia, seizures and respiratory distress. The animal was brought to the veterinary hospital and given a bath, atropine and intravenous fluids. The reporter also indicated at this point that the animal had developed nasal discharge. The caller was told the signs seen were unexpected following the exposure described. She was advised of signs consistent with organophosphate toxicity, and standard treatment protocols. She was provided information regarding registrant supported cholinesterase blood testing to assist in determining etiology. On routine call back the registrant was advised the animal was no longer seizuring and was "doing better". On yet another call back 6 days after the initial contact with the registrant the DVM attending to the animal advised that the animal had died. She stated the animal continued to improve with palliative care but the animal's owner elected to take the animal home and it began seizuring and died at home. The veterinarian was advised this would be unexpected following routine use of the product as labeled. 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