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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2745

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-30355118

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.

02-JUN-12

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

01-JUN-12

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 and Tick Spray for Dogs 16 fl oz

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

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

Pit Bull Terrier

4. Number of animals affected

2

5. Sex

Female

6. Age (provide a range if necessary )

0.7

7. Weight (provide a range if necessary )

Unknown

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 - Anorexia
    • Symptom - Bloody stool
  • General
    • Symptom - Lethargy
  • Renal System
    • Symptom - Blood in urine
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Vomiting
  • General
    • Symptom - Death

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

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

1-30355118- The reporter, a pet owner, indicated his animals were exposed to an insecticidal product containing the active ingredient tetrachlorvinphos and methoprene. The reporter indicated he applied the product to two dogs and a cat. The product is not labeled for cats. The cat remained asymptomatic and a sub form was not created. The application had taken place one day prior to the initial report and the caller stated within 2-3 hours his seven month female Pit-bull dog (Subform III, #1)had developed vomiting , diarrhea, lethargy, blood in stool, hematuria, and loss of appetite. His two year male Pit-bull dog (Subform III, #2) had a similar onset time and developed lethargy, anorexia, diarrhea, and vomiting. The reporter was advised the signs seen would not be anticipated following use per the label her was advised to seek veterinary attention. On follow up the pet owner indicated the female dog had died one day later. The second animal had resolved. No veterinary care was described. The signs and outcome are not consistent with the profile of the active ingredients. 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

Pit Bull Terrier

4. Number of animals affected

2

5. Sex

Male

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

Unknown

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

  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Diarrhea
    • Symptom - Vomiting

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Unknown

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

1-30355118- The reporter, a pet owner, indicated his animals were exposed to an insecticidal product containing the active ingredient tetrachlorvinphos and methoprene. The reporter indicated he applied the product to two dogs and a cat. The product is not labeled for cats. The cat remained asymptomatic and a sub form was not created. The application had taken place one day prior to the initial report and the caller stated within 2-3 hours his seven month female Pit-bull dog (Subform III, #1)had developed vomiting , diarrhea, lethargy, blood in stool, hematuria, and loss of appetite. His two year male Pit-bull dog (Subform III, #2) had a similar onset time and developed lethargy, anorexia, diarrhea, and vomiting. The reporter was advised the signs seen would not be anticipated following use per the label her was advised to seek veterinary attention. On follow up the pet owner indicated the female dog had died one day later. The second animal had resolved. No veterinary care was described. The signs and outcome are not consistent with the profile of the active ingredients. 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