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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-4589

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-27098668

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.

10-AUG-11

5. Location of incident.

Country: UNITED STATES

Prov / State: OKLAHOMA

6. Date incident was first observed.

06-AUG-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. 2596-150

Product Name: UltraGuard Plus Flea Tick Drops Plus for Dogs Puppies

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration 85.7 %
    • D-PHENOTHRIN
      • Guarantee/concentration 2.3 %

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

Beagle

4. Number of animals affected

2

5. Sex

Female

6. Age (provide a range if necessary )

0.08

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Skin

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 - Anorexia
  • General
    • Symptom - Lethargy
    • Symptom - Pale mucous membrane colour
    • 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?

Treatment / Traitement

17. Provide any additional details about the incident

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

1-27098668- The reporter, a pet owner, indicated her animals had been exposed to an insecticidal product containing the active ingredients phenothrin and methoprene. The reporter stated she had applied the product to her two immature (age unknown) 10 pound beagle dogs one month ago. She reported she bathed the dogs with an unidentified insecticidal shampoo four days prior to her contact with the registrant. After the bath when the animals were dried the product was applied to the animals. The following day the animals developed the signs of anorexia, lethargy, and pale mucus membranes. The pets were brought to the caller's veterinarian who advised her to bring them to a local emergency clinic. The pet owner stated one animal died on her way home the other the same day at home. She did not bring them to the emergency clinic. The animals had been buried and no necropsy had been done. The caller indicated she did not believe the product was related to the animal's death but a family member had made her call. The pet owner advised to avoid using multiple overlapping insecticidal products going forward unless the label advises it is acceptable. The label for this product does not. The signs seen would not be expected to be associated with product use. 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