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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2949

2. Registrant Information.

Registrant Reference Number: PROSAR cases: 1-26499912

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.

14-JUN-11

5. Location of incident.

Country: UNITED STATES

Prov / State: SOUTH CAROLINA

6. Date incident was first observed.

12-JUN-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. 2596-147

Product Name: Control One Spot Flea Tick Treatment for Cats

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration 2.9 %

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

Cat / Chat

3. Breed

domestic shorthair

4. Number of animals affected

6

5. Sex

Unknown

6. Age (provide a range if necessary )

0.25

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

  • Gastrointestinal System
    • Symptom - Gagging
    • Symptom - Diarrhea

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.

Yes

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

1-26499912- The reporter, a pet owner, indicates her animals were exposed to an insecticidal product containing the active ingredient methoprene. The pet owner stated she applied the product to seven thirteen week kittens four days prior to her initial contact with the registrant. She reports all animals developed gagging and diarrhea two days following application. She reports she then brought the animal to the veterinarian and they were additionally placed on the product Frontline Plus. The pet owner stated six of the animals (Subform III. #1) were asymptomatic at the time of the call, and one (Subform III, #2) was experiencing labored breathing. The pet owner was advised the signs seen would not be expected following use of the product according to the label. She was advised to seek veterinary attention for the affected animal. On routine follow up the pet owner indicated the animal that had been experiencing labored breath had died two hours after taking them to the vet the day of her initial contact with the registrant. No additional 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

Cat / Chat

3. Breed

domestic shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.25

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

  • Gastrointestinal System
    • Symptom - Gagging
    • Symptom - Diarrhea
  • Respiratory System
    • Symptom - Laboured breathing
  • 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?

Unknown

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

1-26499912- The reporter, a pet owner, indicates her animals were exposed to an insecticidal product containing the active ingredient methoprene. The pet owner stated she applied the product to seven thirteen week kittens four days prior to her initial contact with the registrant. She reports all animals developed gagging and diarrhea two days following application. She reports she then brought the animal to the veterinarian and they were additionally placed on the product Frontline Plus. The pet owner stated six of the animals (Subform III. #1) were asymptomatic at the time of the call, and one (Subform III, #2) was experiencing labored breathing. The pet owner was advised the signs seen would not be expected following use of the product according to the label. She was advised to seek veterinary attention for the affected animal. On routine follow up the pet owner indicated the animal that had been experiencing labored breath had died two hours after taking them to the vet the day of her initial contact with the registrant. No additional 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