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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2957

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-26534851

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.

29-JUN-11

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

Unknown

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. 2596-139

Product Name: UltraGuard Plus Flea Tick Collar for Cats Kittens

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration 1.02 %
    • TETRACHLORVINPHOS
      • Guarantee/concentration 14.55 %

7. b) Type of formulation.

Other (specify)

collar

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

1

5. Sex

Male

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

20

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
  • General
    • Symptom - Vocalizing
  • Gastrointestinal System
    • Symptom - Bloody stool
  • 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

1-26534851- The reporter, a pet owner, indicated her animals had been exposed to an insecticide containing the active ingredient tetrachlorvinphos. The pet owner indicted she applied the product to four cats ten days preceding her initial contact with the registrant. the pet owner stated that one animal, a eight year male twenty pound domestic shorthair (Subform III, #1) developed signs of vocalizing and having tremors some time after the exposure (the caller was unable to clarify the time frame). The pet owner had indicated they did not seek veterinary care due to lack of finances and the animal developed bloody stool one week after application and died eight days after application. The pet owner indicated the three additional cats (Subform III, #2) to which the product had been applied had been lethargic since application. She reported at the time of the call she had removed the collars from the additional animals just prior to the call. The pet owner was advised the signs seen and outcome would be unexpected following use of the product as labeled. She was advised to wash the animals in a noninsecticidal shampoo and seek immediate veterinary care for the animals. On follow up the pet owner indicated she had washed the animal following the initial contact. The animals resumed normal behavior by the next day. No veterinary assistance was sought. 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

Cat / Chat

3. Breed

Domestic shorthair

4. Number of animals affected

3

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Lethargy

12. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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

1-26534851- The reporter, a pet owner, indicated her animals had been exposed to an insecticide containing the active ingredient tetrachlorvinphos. The pet owner indicted she applied the product to four cats ten days preceding her initial contact with the registrant. the pet owner stated that one animal, a eight year male twenty pound domestic shorthair (Subform III, #1) developed signs of vocalizing and having tremors some time after the exposure (the caller was unable to clarify the time frame). The pet owner had indicated they did not seek veterinary care due to lack of finances and the animal developed bloody stool one week after application and died eight days after application. The pet owner indicated the three additional cats (Subform III, #2) to which the product had been applied had been lethargic since application. She reported at the time of the call she had removed the collars from the additional animals just prior to the call. The pet owner was advised the signs seen and outcome would be unexpected following use of the product as labeled. She was advised to wash the animals in a noninsecticidal shampoo and seek immediate veterinary care for the animals. On follow up the pet owner indicated she had washed the animal following the initial contact. The animals resumed normal behavior by the next day. No veterinary assistance was sought. 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