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Consumer Product Safety

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-11

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

10-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. 2596-140

Product Name: UltraGuard Plus Flea Tick Spray for Dogs

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .07 %
    • 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

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

19. Provide supplemental information here