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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2061

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-32682342

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.

07-FEB-13

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

04-FEB-13

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. Unknown

Product Name: Ultraguard Flea/Tick Drops for Dogs 4-15 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?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Yorkshire Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

12

7. Weight (provide a range if necessary )

21

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>24 hrs <=3 days / >24 h <=3 jours

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
  • Nervous and Muscular Systems
    • Symptom - Stiffness
  • Gastrointestinal System
    • Symptom - Diarrhea
  • Nervous and Muscular Systems
    • Symptom - Collapse
  • Respiratory System
    • Symptom - Cyanosis
    • Symptom - Respiratory distress
  • General
    • Symptom - Death
  • Liver
    • Symptom - Enlargement of the liver
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Other
    • Specify - gums were pink

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

1-32682342 - The reporter, a veterinary, indicated that a dog was exposed to an insecticidal spot-on product containing the active ingredient phenothrin. The reporter indicated that the pet owner applied the spot-on product to her 12-year-old, 21 pound, male Yorkshire terrier four days prior to initial contact with the registrant. The following morning the pet owner reported that the dog was lethargic and seemed stiff; the dog didnt want to pick up his head. The pet owner brought the dog to the reporter later that day. The reporter indicated that she had not seen the animal for about 5 years and was therefore not familiar with the dogs recent health history. The reporter stated that at presentation the dogs gums were pink, he did not appear stiff but he was suffering from diarrhea. They bathed the dog at the veterinary clinic. While still at the clinic the dog started to vomit; after it vomited it collapsed, turned blue and went into respiratory distress. Attempts to revive the animal were unsuccessful. The reporter, who is a veterinarian, did her own gross necropsy and noted an enlarged liver. The reporter was advised that per package labeling the product should not be applied to an aged animal without first consulting a veterinarian. The described symptoms are not typically seen with exposure to the product and there are numerous other possible causes for the described symptoms. To help determine a cause for death the possibility of a full necropsy was discussed but the reporter indicated that the dog had already been submitted for cremation. 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