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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-5257

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-27439315

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.

15-SEP-11

5. Location of incident.

Country: UNITED STATES

Prov / State: CONNECTICUT

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. 2596-78

Product Name: UltraGuard Flea Tick Powder for Cats

  • Active Ingredient(s)
    • TETRACHLORVINPHOS
      • Guarantee/concentration 3.3 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2596-79

Product Name: UltraGuard Flea Tick Powder for Dogs

  • Active Ingredient(s)
    • TETRACHLORVINPHOS
      • Guarantee/concentration 3.3 %

7. b) Type of formulation.

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 )

5

7. Weight (provide a range if necessary )

13

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Seizure
  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Muscle weakness
  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Other
    • Specify - Limp
    • Symptom - Difficulty getting up
  • Gastrointestinal System
    • Symptom - Anorexia
    • Specify - refused to eat

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

1-27439315- The reporter, a pet owner, indicates her animals were exposed to two products both containing the active ingredient tetrachlorvinphos one labeled for use on dogs the other labeled for use on cats. The pet owner indicated she applied the feline product to her five year female thirteen pound domestic shorthair cat one month prior to her initial contact with the registrant. She reported one hour after application the animal had a seizure and was lethargic. Two days later they found the animal limp and it had multiple seizures over the course of three hours. It then died. She did not seek veterinary assistance for the animal. The caller states she applied the canine product to her ten year twelve pound male Toy Poodle. She did indicate when she had applied that product but stated the animal was the next day unable to stand, refused to eat, and had generalized muscle weakness. She then bathed the animal with a hand dish washing liquid and the animals signs spontaneously resolve within four days. The pet owner was advised the signs seen and out come seen would not be expected following use of the products per the label recommendations. 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

Dog / Chien

3. Breed

Toy Poodle

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

10

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

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

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Difficulty getting up
  • Gastrointestinal System
    • Symptom - Anorexia
  • Nervous and Muscular Systems
    • Symptom - Muscle weakness

12. How long did the symptoms last?

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

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

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

1-27439315- The reporter, a pet owner, indicates her animals were exposed to two products both containing the active ingredient tetrachlorvinphos one labeled for use on dogs the other labeled for use on cats. The pet owner indicated she applied the feline product to her five year female thirteen pound domestic shorthair cat one month prior to her initial contact with the registrant. She reported one hour after application the animal had a seizure and was lethargic. Two days later they found the animal limp and it had multiple seizures over the course of three hours. It then died. She did not seek veterinary assistance for the animal. The caller states she applied the canine product to her ten year twelve pound male Toy Poodle. She did indicate when she had applied that product but stated the animal was the next day unable to stand, refused to eat, and had generalized muscle weakness. She then bathed the animal with a hand dish washing liquid and the animals signs spontaneously resolve within four days. The pet owner was advised the signs seen and out come seen would not be expected following use of the products per the label recommendations. No further 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