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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-0834

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-24470404

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.

20-OCT-10

5. Location of incident.

Country: UNITED STATES

Prov / State: MICHIGAN

6. Date incident was first observed.

19-OCT-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. 2596-126

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Yorkshire Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

9

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

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Seizure
    • Symptom - Rigidity
  • Respiratory System
    • Symptom - Difficulty Breathing
  • General
    • Symptom - Death
    • Symptom - Pain
  • Nervous and Muscular Systems
    • Symptom - Semi comatose
  • Cardiovascular System
    • Symptom - Other
    • Specify - heart attack

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?

Unknown

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

1-24470404- The reporter, a pet owner, indicates her animal was exposed to an insecticide containing the active ingredient tetrachlorvinphos. The pet owner indicated she applied the product; a flea and tick spray for cats, to her nine year five pound male Yorkshire terrier dog four days prior to the initial contact with the registrant. The owner indicates the animal demonstrated no signs until the day prior to the initial contact with the registrant. The animal was found in the home the day prior laying on his side struggling to breathe. The pet owner indicates when the animal was picked up it screamed in pain. The animal was brought to the veterinarian and treated for what was suspected to be an ┐┐┐allergic reaction? with unknown injectable medications. The pet owner indicated the animal became rigid while the veterinarian was working on it and began having seizures. The pet owner indicates the animal was left in the care of the veterinarian and several hours later they were called and told the seizures were not abating, the animal may have had a ┐┐┐heart attack? and it was ┐┐┐semi-comatose?. The pet owner indicated the veterinarian called in the morning and had stated the animal had died the prior evening. The pet owner was advised the onset and signs seen were both inconsistent with exposure to the active ingredient in the concentration seen. The pet owner was offered registrant supported cholinesterase testing and necropsy. She indicated she was not likely to pursue these diagnostics. 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