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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-2239
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-25849485
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.
12-APR-115. Location of incident.
Country: UNITED STATES
Prov / State: CALIFORNIA
6. Date incident was first observed.
10-APR-11Product 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. 2596-140
Product Name: UltraGuard Plus Flea Tick Spray for Dogs
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .07 %
- TETRACHLORVINPHOS
- Guarantee/concentration 1.08 %
- (S)-METHOPRENE
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
Mixed breed dog
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
4
7. Weight (provide a range if necessary )
8
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Agitation
- Symptom - Aggressive behaviour
- Eye
- Symptom - Pupil dilation
- General
- Symptom - Death
- Nervous and Muscular Systems
- Symptom - Ataxia
- Symptom - Muscle tremors
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
1-25849485- The caller, a pet owner, indicated exposure of her five animals to an insecticidal product containing the active ingredients tetrachlorvinphos and methoprene. The pet owner indicated she applied the product to her four year female eight pound mixed breed dog (Subform III#1) two days prior to her initial contact with the registrant. The animal immediately following application became agitated, jumpy nervous frantic, its pupils were dilated, and it began licking itself. The pet owner indicated the animal ran into an orange grove adjacent to her property and did not return home. The pet was found dead in the orange grove the day prior to the pet owner¿s initial contact with the registrant. The pet owner stated she also applied the same product to four other dogs in her home (Subform III #2). Those pets did not show the same signs as the previously mentioned animal but at the point of contact all those animals demonstrated lethargy. The pet owner was advised of the unexpectedness of the signs seen. It was recommended she seek veterinary assistance to determine the cause of her animals¿ illness and the appropriate treatment approach. 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
Unknown
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
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- General
- Symptom - Lethargy
12. How long did the symptoms last?
Unknown / Inconnu
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
Unknown/Inconnu
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
1-25849485- The caller, a pet owner, indicated exposure of her five animals to an insecticidal product containing the active ingredients tetrachlorvinphos and methoprene. The pet owner indicated she applied the product to her four year female eight pound mixed breed dog (Subform III#1) two days prior to her initial contact with the registrant. The animal immediately following application became agitated, jumpy nervous frantic, its pupils were dilated, and it began licking itself. The pet owner indicated the animal ran into an orange grove adjacent to her property and did not return home. The pet was found dead in the orange grove the day prior to the pet owner¿s initial contact with the registrant. The pet owner stated she also applied the same product to four other dogs in her home (Subform III #2). Those pets did not show the same signs as the previously mentioned animal but at the point of contact all those animals demonstrated lethargy. The pet owner was advised of the unexpectedness of the signs seen. It was recommended she seek veterinary assistance to determine the cause of her animals¿ illness and the appropriate treatment approach. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
