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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3928

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-26830915

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-JUL-11

5. Location of incident.

Country: UNITED STATES

Prov / State: PENNSYLVANIA

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. 2596-140

Product Name: UltraGuard Plus Flea Tick Spray for Cats

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .07 %
    • TETRACHLORVINPHOS
      • Guarantee/concentration 1.08 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2596-83

Product Name: UltraGuard Flea Tick Collar for Cats

  • Active Ingredient(s)
    • TETRACHLORVINPHOS
      • Guarantee/concentration 14.55 %

7. b) Type of formulation.

Liquid

Dust

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

Cat / Chat

3. Breed

domestic shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

12

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

  • Skin
    • Symptom - Pruritus
  • Gastrointestinal System
    • Symptom - Anorexia
  • Nervous and Muscular Systems
    • Symptom - Seizure
  • Skin
    • Symptom - Lesion
    • Specify - "scab"
  • General
    • Symptom - Death
  • Blood
    • Symptom - Bleeding

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

1-26830915- The reporter, a pet owner indicates her animal was exposed to two insecticidal products. One containing the active ingredients tetrachlorvinphos and methoprene the other containing the active ingredient tetrachlorvinphos. The pet owner stated she applied the products to her eight year female twelve pound domestic shorthair cat at some undeclared time frame preceding the initial report. The pet owner stated she first applied the spray containing the two active ingredients and then applied a collar containing the one active ingredient alone. The pet owner indicated the animal had a seizure immediately following application of the spray product. The animal also refused food or drink. She reported at some indeterminate time frame the pet began scratching itself to the point of bleeding and the collar was removed. The caller indicated the collar was on the animal no more than one day. The animal was also bathed. The pet owner stated the animal had died two days prior to her initial report. The animal was not brought to the veterinarian due to the pet owners limited financial resources. The pet owner disconnected during history collection and could not be further reached to clarify history. In this circumstance the pet owner did not follow label directions applying multiple overlapping products. 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