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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3063

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-31055056

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.

31-JUL-12

5. Location of incident.

Country: UNITED STATES

Prov / State: MINNESOTA

6. Date incident was first observed.

23-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. 2596-151

Product Name: UltraGuard Pro Flea and Tick Drops for Dogs and Puppies Over 60 lbs

  • Active Ingredient(s)
    • D-PHENOTHRIN
      • Guarantee/concentration 85.7 %

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

Labrador Retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

75

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

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Anorexia

12. How long did the symptoms last?

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

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

1-31055056 - The reporter, a pet owner, indicated that her two dogs were exposed to an insecticidal product containing the active ingredient phenothrin. The pet owner reported that she applied this product to her 3-year-old, 75 pound, male Labrador Retriever named Lark (Subform III #1) and to her 3-year-old, 75 pound, male Labrador Retriever named Duke (Subform III #2) nine days prior to initial contact with the registrant. The following day Lark vomited intermittently throughout the day and was not eating. His symptoms resolved the next day. Four days prior to initial contact with the registrant, 5 days after product application, Duke was lethargic, not eating, and not getting up or walking. Duke was brought to the veterinarian and blood work showed an increased red blood cell count; which the veterinarian indicated was due to dehydration. A high fever and black stools were noted on exam. The dog was treated with intravenous fluids for the day and then sent home. That night at 1am the caller found the dog dead with blood coming out of his rectum. Caller was advised that stomach upset can be seen with ingestion of the product but Dukes symptoms would not be expected. Caller was further advised that there are numerous possible causes for the symptoms that were seen with Duke including exposure to rodenticides. 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

Dog / Chien

3. Breed

Labrador Retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

75

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Difficulty getting up
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
  • Blood
    • Symptom - Other
    • Specify - High red cell count
  • Gastrointestinal System
    • Symptom - Melena
    • Symptom - Rectal hemorrhage
  • General
    • Symptom - Fever
    • 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?

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

1-31055056 - The reporter, a pet owner, indicated that her two dogs were exposed to an insecticidal product containing the active ingredient phenothrin. The pet owner reported that she applied this product to her 3-year-old, 75 pound, male Labrador Retriever named Lark (Subform III #1) and to her 3-year-old, 75 pound, male Labrador Retriever named Duke (Subform III #2) nine days prior to initial contact with the registrant. The following day Lark vomited intermittently throughout the day and was not eating. His symptoms resolved the next day. Four days prior to initial contact with the registrant, 5 days after product application, Duke was lethargic, not eating, and not getting up or walking. Duke was brought to the veterinarian and blood work showed an increased red blood cell count; which the veterinarian indicated was due to dehydration. A high fever and black stools were noted on exam. The dog was treated with intravenous fluids for the day and then sent home. That night at 1am the caller found the dog dead with blood coming out of his rectum. Caller was advised that stomach upset can be seen with ingestion of the product but Dukes symptoms would not be expected. Caller was further advised that there are numerous possible causes for the symptoms that were seen with Duke including exposure to rodenticides. 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