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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-4609

2. Registrant Information.

Registrant Reference Number: Case # 1-27299973

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.

30-AUG-11

5. Location of incident.

Country: CANADA

Prov / State: NEW BRUNSWICK

6. Date incident was first observed.

22-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. 25621      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Flea Tick Collar for Cats Kittens

  • Active Ingredient(s)
    • TETRACHLORVINPHOS

7. b) Type of formulation.

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 Longhair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

14

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

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
  • Nervous and Muscular Systems
    • Symptom - Ataxia
  • Gastrointestinal System
    • Symptom - Gagging

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

Euthanised / Euthanasie

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

1-27299973- The reporter, a pet owner, indicated her animals were exposed to an insecticidal product containing the active ingredient tetrachlorvinphos. The reporter indicated she applied the product, a flea and tick collar labeled for use on cats, to her fourteen year ten pound male domestic shorthair cat (Subform III, #1) and her three year male twelve pound domestic shorthair cat (Subform III, #2) ten days prior to her initial contact with the registrant. The pet owner indicated the older animal developed vomiting, ataxia and choking within two days of application. The younger animal developed salivation, hair loss, and raw skin/fur looks melted to skin within two days of application. The collars were removed two days of application. The older animal was brought to the veterinarian and euthanized. No treatment or diagnostics were performed. The pet owner was advised the product, when used according to the label, is safe. This product is not labeled for geriatric animals. It was advised she seek veterinary care for the remaining animal. On follow up the pet owner indicated the pet had a general blood chemistry which was pending and an antibiotic injection. The animal was improving. 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

1

5. Sex

Male

6. Age (provide a range if necessary )

3

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

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Salivating excessively
  • Skin
    • Symptom - Hair loss
    • Symptom - Irritated skin
    • Specify - raw skin/fur looks melted to skin

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?

Treatment / Traitement

17. Provide any additional details about the incident

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

1-27299973- The reporter, a pet owner, indicated her animals were exposed to an insecticidal product containing the active ingredient tetrachlorvinphos. The reporter indicated she applied the product, a flea and tick collar labeled for use on cats, to her fourteen year ten pound male domestic shorthair cat (Subform III, #1) and her three year male twelve pound domestic shorthair cat (Subform III, #2) ten days prior to her initial contact with the registrant. The pet owner indicated the older animal developed vomiting, ataxia and choking within two days of application. The younger animal developed salivation, hair loss, and 'raw skin/fur looks melted to skin' within two days of application. The collars were removed two days of application. The older animal was brought to the veterinarian and euthanized. No treatment or diagnostics were performed. The pet owner was advised the product, when used according to the label, is safe. This product is not labeled for geriatric animals. It was advised she seek veterinary care for the remaining animal. On follow up the pet owner indicated the pet had a general blood chemistry which was pending and an antibiotic injection. The animal was improving. 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