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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-5630

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-27949292

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.

29-OCT-11

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

29-OCT-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. 2596-140

Product Name: UltraGuard Plus Flea Tick Spray for Dogs

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

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2596-153

Product Name: UltraGuard Rid Flea Tick Shampoo with Oatmeal for Dogs

  • Active Ingredient(s)
    • D-PHENOTHRIN
      • Guarantee/concentration .27 %

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Staffordshire Bull Terrier

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1.16

7. Weight (provide a range if necessary )

47

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

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Aggressive behaviour
  • Gastrointestinal System
    • Symptom - Salivating excessively
    • Symptom - Bloody vomit
    • Symptom - Bloody stool
  • General
    • Symptom - Dehydration
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

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

1-27949292- The reporter, a pet owner, indicated her animal was exposed to two insecticidal products. Te first contained the active ingredient phenothrin, the second tetrachlorvinphos and methoprene. The pet owner indicated she first bathed her fourteen month female forty-seven pound Staffordshire bull terrier with the former product and then applied the latter product as a spray to the animal. The application was done the night prior to her initial contact with the registrant. The pet owner indicated awakened her in the middle of the night vomiting and by morning she had diarrhea. Just prior to her initial contact she had noted blood in the animals vomit and diarrhea. The pet was also lethargic drooling and confused. The pet owner was advised to bathe the animal with a noninsecticidal shampoo and seek veterinary attention as needed for supportive care. The pet owner┐s veterinarian called later the same evening and was provided current standards of care following overdosage scenarios. One more follow up was obtained from the attending veterinarian that same evening. She reports the animal responded favorably to supportive care. Low dose atropine yielded a HR of 140 BPM. The veterinarian was advised to discontinue atropine and further support the animal after verifying the animal had been bathed with a noninsecticidal shampoo. On follow up the pet owner indicated the pet had died after it returned home from the veterinary clinic. The pet owner was advised of registrant supported necropsy to assist in determining the cause of death. The pet owner did not submit the animal for necropsy. The signs and out come would not be expected following use of the products as labeled. 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