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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2235

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-25800119

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.

06-APR-11

5. Location of incident.

Country: UNITED STATES

Prov / State: OHIO

6. Date incident was first observed.

01-APR-11

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 31-60 lbs

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

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

Boxer

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.26

7. Weight (provide a range if necessary )

13

lbs

8. Route(s) of exposure

Skin

Oral

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

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
    • Symptom - Anorexia
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Unknown

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-25800119- The reporter, a pet owner, calls to indicate exposure of her animals to a pesticide containing the active ingredient phenothrin. The pet owner stated she applied the product to her five dogs one week prior to the initial contact with the registrant. The pet owner reported within 24 hours all animals developed vomiting and diarrhea. She reports all animals were brought to the veterinarian where the veterinarian had done a Parvoviral test that proved to be negative. The veterinarian had expressed the opinion that the animals were suffering from a viral infection to the owner and had recommended the animal be kept well hydrated at home. The pet owner indicated all dogs(Subform III, #2) except one resolved spontaneously within 48 hours. She indicated her fourteen week thirteen pound male boxer dog (Subform III, #1) developed anorexia upon returning home from the veterinarian and was found dead the morning of her initial contact with the registrant. The caller indicates the product was applied topically as labeled, but hypothesizes that the product may have been licked of the back of housemates. She did not observe ingestion. The pet owner was advised the symptoms seen were not consistent with the toxicity profile of the active ingredient. 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

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

mixed breed

4. Number of animals affected

4

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Vomiting

12. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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

Unknown

14. a) Was the animal hospitalized?

Unknown

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

1-25800119- The reporter, a pet owner, calls to indicate exposure of her animals to a pesticide containing the active ingredient phenothrin. The pet owner stated she applied the product to her five dogs one week prior to the initial contact with the registrant. The pet owner reported within 24 hours all animals developed vomiting and diarrhea. She reports all animals were brought to the veterinarian where the veterinarian had done a Parvoviral test that proved to be negative. The veterinarian had expressed the opinion that the animals were suffering from a viral infection to the owner and had recommended the animal be kept well hydrated at home. The pet owner indicated all dogs(Subform III, #2) except one resolved spontaneously within 48 hours. She indicated her fourteen week thirteen pound male boxer dog (Subform III, #1) developed anorexia upon returning home from the veterinarian and was found dead the morning of her initial contact with the registrant. The caller indicates the product was applied topically as labeled, but hypothesizes that the product may have been licked of the back of housemates. She did not observe ingestion. The pet owner was advised the symptoms seen were not consistent with the toxicity profile of the active ingredient. 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