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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-0838

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-24623381

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.

05-NOV-10

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

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. 29283      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Pro Flea Tick Drops for Dogs Puppies Under 30 lbs

  • Active Ingredient(s)
    • (S)-METHOPRENE
    • 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

unknown

4. Number of animals affected

2

5. Sex

Unknown

6. Age (provide a range if necessary )

0.23

7. Weight (provide a range if necessary )

Unknown

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 - Muscle tremors

12. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 h

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

Fully Recovered / Complètement rétabli

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

1-24623381- The reporter, a pet owner, indicated exposure of her animals to an insecticide containing the active ingredients methoprene and permethrin. The pet owner indicates she applied the product to her kittens which she suspected but did not know were 12 weeks of age. She did not specify when the product was applied. Upon initial contact with the registrant the pet owner was ambivalent about the specific product used as she had discarded the packaging. She was able to state the product was a registrant product labeled for dogs. The animals were reported to have been ¿¿¿shivering? the night prior to her initial contact with the registrant. The morning of the initial contact the animals were tremoring. The pet owner was told concentrated canine pyrethrin/pyrethroid spot-on type products can result in significant problems if inappropriately used on cats. She was advised of proper decontamination and told to seek prompt veterinary care. On routine follow up the pet owner identified the product used and indicated she had a washed the animals. She noted signs spontaneously resolve and did not seek veterinary assistance. No further information is available.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here