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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-4184
2. Registrant Information.
Registrant Reference Number: PROSAR Case#: 1-31198243
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.
13-AUG-125. Location of incident.
Country: UNITED STATES
Prov / State: FLORIDA
6. Date incident was first observed.
Unknown
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. 2596-150
Product Name: UltraGuard Pro Flea/TIck Drops Plus for Dogs Puppies
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration 2.3 %
- D-PHENOTHRIN
- Guarantee/concentration 85.7 %
- (S)-METHOPRENE
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
Dog / Chien
3. Breed
American Pit Bull
4. Number of animals affected
3
5. Sex
Unknown
6. Age (provide a range if necessary )
0.04
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Unknown
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 - Pale mucous membrane colour
- Reproductive System
- Symptom - Other
- Specify - Fading puppy syndrome
- General
- Symptom - Death
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
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
1-31198243 - The reporter, a veterinarian, indicated that a pregnant dog was exposed to a spot-on insecticidal product containing the active ingredients methoprene and phenothrin. The veterinarian reported that the product was applied to a pregnant, American pit-bull, at some unknown time during the dogs pregnancy. Two weeks prior to initial contact with the registrant the mother gave birth to 6 puppies and since that time 3 of the puppies (Subform III #1) have died. The reporter indicated that she has not yet examined the animals but per the pet owner the three puppies that died developed pale gums and seemed to fade prior to death. The pet owner indicated to the reporter that she thought it was possible that the mother dog had rolled on the puppies which may have caused them to pass away. According to the pet owner the other 3 puppies are currently fine. The reporter was advised that use of this product on pregnant dogs has not been tested and the product label indicates that the product should not be applied to pregnant dogs. The results of use of this product on a pregnant dog is unknown but A full work-up was recommended to help determine the cause for the death of the puppies. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
