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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3179

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-33774561

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.

24-MAY-13

5. Location of incident.

Country: CANADA

Prov / State: NEWFOUNDLAND

6. Date incident was first observed.

23-MAY-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. 26489      PMRA Submission No.       EPA Registration No.

Product Name: Ultraguard Plus Flea/Tick Drops for Dogs/Puppies Under 30 lbs

  • Active Ingredient(s)
    • (S)-METHOPRENE
    • PERMETHRIN

7. b) Type of formulation.

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

Chihuahua

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1.5

7. Weight (provide a range if necessary )

3.5

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Difficulty walking
    • Specify - Walking on three legs

12. How long did the symptoms last?

Unknown / Inconnu

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

Yes

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

1-33774561 - The reporter, a pet owner, indicated that her dog was exposed to a spot-on insecticide containing the active ingredients permethrin and methoprene . The reporter no longer had the product packaging and could not provide the PCP number or bar code but she was told by the store where she purchased the product that the active ingredients in the product were permethrin and methoprene. The reporter states that she applied the product to her 1 5 year old, male, 3.5 pound Chihuahua one day prior to initial contact with the registrant. Fifteen minutes after application the dog vomited one time and then was laying around the rest of the day. The reporter bathed her dog that evening and again the following morning with a non-insecticidal soap. On the day of initial contact, the reporter indicated that her dog was now walking on three legs and rolling around a lot. The reporter had an appointment with her veterinarian later in the day. The reporter was advised that licking the application site can cause a bad taste and may lead to transient vomiting or hypersalivation soon after exposure. Some animals may have a sensitivity to the product and can experience dermal irritation. Walking on three legs is not consistent with product exposure. The reporter was advised to seek veterinary care to help determine an underlying cause for this symptom and appropriate treatment. The reporter could not be reached for follow-up. 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