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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3059

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-30954168

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.

23-JUL-12

5. Location of incident.

Country: UNITED STATES

Prov / State: CONNECTICUT

6. Date incident was first observed.

22-JUL-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. 2596-22

Product Name: UltraGuard Rid Flea and Tick Shampoo for Cats

  • Active Ingredient(s)
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Guarantee/concentration .149 %
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration .089 %
    • PYRETHRINS
      • Guarantee/concentration .045 %

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?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Short Hair

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0.16

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

Unknown / Inconnu

11. List all symptoms

System

  • 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

1-30954168 - The reporter, a pet owner, indicated that four of his cats were exposed to an insecticide product containing the active ingredients pyrethrins, n-octyl bicycloheptane dicarboximide and piperonyl butoxide. The pet owner reported he shampooed and bathed his 2 month-old domestic shorthair(Subform III #1), his 6-year-old domestic short hair (Subform III #2), his 7-year-old domestic short hair (Subform III #3) and his 4-year-old domestic shorthair (Subform III #4) with this product one day prior to initial contact with the registrant. The following morning, the reporter indicated that his 2-month-old and his 6-year-old cats passed away suddenly with no symptoms prior to their death and his 7-year-old and 4-year-old cats were lethargic. The reporter was advised that per package labeling the product should not be applied to animals less than 12 weeks of age. He was further advised to bath his two lethargic cats with a non-insecticidal shampoo and lukewarm water and to seek veterinary care if symptoms persist or worsen. 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

Unknown

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • 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

1-30954168 - The reporter, a pet owner, indicated that four of his cats were exposed to an insecticide product containing the active ingredients pyrethrins, n-octyl bicycloheptane dicarboximide and piperonyl butoxide. The pet owner reported he shampooed and bathed his 2 month-old domestic shorthair(Subform III #1), his 6-year-old domestic short hair (Subform III #2), his 7-year-old domestic short hair (Subform III #3) and his 4-year-old domestic shorthair (Subform III #4) with this product one day prior to initial contact with the registrant. The following morning, the reporter indicated that his 2-month-old and his 6-year-old cats passed away suddenly with no symptoms prior to their death and his 7-year-old and 4-year-old cats were lethargic. The reporter was advised that per package labeling the product should not be applied to animals less than 12 weeks of age. He was further advised to bath his two lethargic cats with a non-insecticidal shampoo and lukewarm water and to seek veterinary care if symptoms persist or worsen. 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

Unknown

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Lethargy

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

1-30954168 - The reporter, a pet owner, indicated that four of his cats were exposed to an insecticide product containing the active ingredients pyrethrins, n-octyl bicycloheptane dicarboximide and piperonyl butoxide. The pet owner reported he shampooed and bathed his 2 month-old domestic shorthair(Subform III #1), his 6-year-old domestic short hair (Subform III #2), his 7-year-old domestic short hair (Subform III #3) and his 4-year-old domestic shorthair (Subform III #4) with this product one day prior to initial contact with the registrant. The following morning, the reporter indicated that his 2-month-old and his 6-year-old cats passed away suddenly with no symptoms prior to their death and his 7-year-old and 4-year-old cats were lethargic. The reporter was advised that per package labeling the product should not be applied to animals less than 12 weeks of age. He was further advised to bath his two lethargic cats with a non-insecticidal shampoo and lukewarm water and to seek veterinary care if symptoms persist or worsen. 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

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

Unknown

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Lethargy

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

1-30954168 - The reporter, a pet owner, indicated that four of his cats were exposed to an insecticide product containing the active ingredients pyrethrins, n-octyl bicycloheptane dicarboximide and piperonyl butoxide. The pet owner reported he shampooed and bathed his 2 month-old domestic shorthair(Subform III #1), his 6-year-old domestic short hair (Subform III #2), his 7-year-old domestic short hair (Subform III #3) and his 4-year-old domestic shorthair (Subform III #4) with this product one day prior to initial contact with the registrant. The following morning, the reporter indicated that his 2-month-old and his 6-year-old cats passed away suddenly with no symptoms prior to their death and his 7-year-old and 4-year-old cats were lethargic. The reporter was advised that per package labeling the product should not be applied to animals less than 12 weeks of age. He was further advised to bath his two lethargic cats with a non-insecticidal shampoo and lukewarm water and to seek veterinary care if symptoms persist or worsen. 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