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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2672

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-26058797

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-MAY-11

5. Location of incident.

Country: UNITED STATES

Prov / State: MISSOURI

6. Date incident was first observed.

04-MAY-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. 2596-22

Product Name: UltraGuard Rid Flea Dog Shampoo Refreshing Fresh Citrus

  • Active Ingredient(s)
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Guarantee/concentration .149 %
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration .089 %
    • PYRETHRINS
      • Guarantee/concentration .045 %

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?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Rottweiler

4. Number of animals affected

5

5. Sex

Unknown

6. Age (provide a range if necessary )

0.076

7. Weight (provide a range if necessary )

3

lbs

8. Route(s) of exposure

Unknown

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 - Bloody stool
  • Cardiovascular System
    • Symptom - Heart murmur

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-26058797- The reporter, a pet owner, indicates her animal was exposed to an insecticidal product containing the active ingredients pyrethrins, piperonyl butoxide, and n-octyl bicycloheptene dicarboximide. The pet owner indicated she washed her adult nursing female dog the day prior to her initial contact with the registrant. Following the bath she realized the product was not labeled for nursing female dogs. The mother dog was kept separated from her puppies and the pet owner contacted her veterinarian for advice. The veterinarian indicated the pet owner should wash the animal again with a non-insecticidal shampoo concentrating on the area surrounding the dog¿s nipples and keep the puppies separate from the mother for two hours following the bath. The owner indicates she followed the veterinarian¿s instructions. The morning of the caller¿s initial contact with the registrant she stated she noted bloody stool in all six four week three pound Rottweiler puppies. She reports one female puppy (Subform III, #2) refused to eat. The pet owner was advised no exposure was described and that the signs seen were inconsistent with the toxicity profile of the active ingredients. She was advised to seek veterinary care for the animals. On call back the pet owner stated the animals were brought to the veterinarian. Five of the six dogs were found to have a heart murmur (Subform III, #1), and were beyond that point asymptomatic. The remaining animal (Subform III#2) was stated by the caller to have been determined to be 'to far gone' by the veterinarian. It was brought home and died the day after the initial contact with the registrant. The pet owner did not elucidate care given by the veterinarian or diagnosis on call back. 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

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Rottweiler

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.076

7. Weight (provide a range if necessary )

3

lbs

8. Route(s) of exposure

Unknown

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 - Bloody stool
    • 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.

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-26058797- The reporter, a pet owner, indicates her animal was exposed to an insecticidal product containing the active ingredients pyrethrins, piperonyl butoxide, and n-octyl bicycloheptene dicarboximide. The pet owner indicated she washed her adult nursing female dog the day prior to her initial contact with the registrant. Following the bath she realized the product was not labeled for nursing female dogs. The mother dog was kept separated from her puppies and the pet owner contacted her veterinarian for advice. The veterinarian indicated the pet owner should wash the animal again with a non-insecticidal shampoo concentrating on the area surrounding the dog¿s nipples and keep the puppies separate from the mother for two hours following the bath. The owner indicates she followed the veterinarian¿s instructions. The morning of the caller¿s initial contact with the registrant she stated she noted bloody stool in all six four week three pound Rottweiler puppies. She reports one female puppy (Subform III, #2) refused to eat. The pet owner was advised no exposure was described and that the signs seen were inconsistent with the toxicity profile of the active ingredients. She was advised to seek veterinary care for the animals. On call back the pet owner stated the animals were brought to the veterinarian. Five of the six dogs were found to have a heart murmur (Subform III, #1), and were beyond that point asymptomatic. The remaining animal (Subform III#2) was stated by the caller to have been determined to be 'to far gone' by the veterinarian. It was brought home and died the day after the initial contact with the registrant. The pet owner did not elucidate care given by the veterinarian or diagnosis on call back. 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