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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-5625

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-27713302

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.

17-OCT-11

5. Location of incident.

Country: UNITED STATES

Prov / State: OHIO

6. Date incident was first observed.

10-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 %

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Norwegian Forest

4. Number of animals affected

1

5. Sex

Male

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

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

11. List all symptoms

System

  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
  • Eye
    • Symptom - Discharge eye
  • Gastrointestinal System
    • Symptom - Salivating excessively
  • Nervous and Muscular Systems
    • Symptom - Muscle weakness
    • Symptom - Ataxia
  • Skin
    • Symptom - Other
    • Specify - Skin sloughing off nasal planum
  • Gastrointestinal System
    • Symptom - Diarrhea
  • General
    • 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

1-27713302- The reporter, pet owner, indicated his animal was exposed to an insecticidal product containing the active ingredient methoprene. The pet owner indicated he had applied the product to his eight year male twelve pound Norwegian Forest cat eight days prior to his initial contact with the registrant. The day after application the pet owner observed the animal was lethargic, refused to eat and appeared to have an ocular infection. The pet owner indicated he had treated the animals eye with a medication he had left over from another incident. The second day after application the animal was reported to salivate heavily, experience muscle weakness, a stumbling gait and loss of appetite. The third day after application the animals muscle weakness and ocular signs persisted, the animal also sloughed skin from its planum and had diarrhea. The pet owner contacted a pet store and was advised to wash the animal with a non insecticidal shampoo, which he did. The pet owner indicated the animal died four days after application. The animal was not brought to a veterinarian. The animals remains had been buried. 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