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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3754

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-33894981

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.

05-JUN-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

31-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. 25923      PMRA Submission No.       EPA Registration No.

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

  • Active Ingredient(s)
    • 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

Shih Tzu

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

8

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

  • General
    • Symptom - Swelling
  • Skin
    • Symptom - Itchy skin

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

1-33894981 - The reporter, a pet owner, indicated that her dogs were exposed to a spot-on insecticide containing the active ingredient permethrin. The reporter did not have the product packaging at the time of contact and could not provide the PCP number or bar code but she was able to provide the full name of the product. The reporter states that she applied the product to her 1 year old, female, 8 pound Shih Tzu (Subform III #1) five days prior to initial contact with the registrant and also to her 9 year old Schnauzer. Later that same day, the reporters Shih Tzu suffered from skin swelling at the base of the tail and the dog became very itchy. The reporters Schnauzer did not develop any symptoms from the exposure. The reporter bathed her Shih Tzu with a non-insecticidal shampoo but the dog was still itchy at the time of initial contact. The reporter was advised that there are numerous possible causes for the described symptoms including a possible sensitivity to the product. Veterinary care was recommended for any persistent or severe symptoms. On follow-up call, two days later, the reporter indicated that her Shih Tzu still had an itchy rear end. The dog had not been to the veterinarian yet but had an appointment scheduled for the following day. 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