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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3762

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-34103805

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-JUN-13

5. Location of incident.

Country: UNITED STATES

Prov / State: VIRGINIA

6. Date incident was first observed.

20-JUN-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. 2596-140

Product Name: Ultraguard Plus Flea/Tick Spray for Dogs

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .07 %
    • TETRACHLORVINPHOS
      • Guarantee/concentration 1.08 %

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

Chihuaha

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.375

7. Weight (provide a range if necessary )

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

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Death
  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Anorexia

12. How long did the symptoms last?

Persisted until death

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

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

1-34103805 - The reporter, a pet owner, indicated that her two dogs were exposed to an insecticidal spray containing the active ingredients tetrachlorvinphos and methoprene. The reporter indicated that she applied the spray to her ~4.5 month-old, 5 pound, male Chihuahua and to her ~4.5 month-old, 5 pound female Chihuahua four days prior to initial contact with the registrant. The reporter indicated that her male Chihuahua vomited and was not eating after product application and then died later that same day. At the time of initial contact, the reporters female Chihuahua was suffering from vomiting, bloody diarrhea and anorexia. The female dog had been bathed with a hand dishwashing soap two days prior to initial contact. The reporter was advised that there are numerous possible causes for the described symptoms. A necropsy was recommended to determine an underlying cause for the male dogs death and immediate veterinary evaluation was recommended for the female dog. On follow-up call, one day later, the reporter indicated that the female dog died yesterday just as they were getting ready to take it to the veterinarian. The reporter declined a necropsy on both of her dogs. 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

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

Female

6. Age (provide a range if necessary )

0.375

7. Weight (provide a range if necessary )

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

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Anorexia
  • General
    • Symptom - Death
  • Gastrointestinal System
    • Symptom - Bloody diarrhea

12. How long did the symptoms last?

Persisted until death

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

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

1-34103805 - The reporter, a pet owner, indicated that her dogs were exposed to an insecticidal spray containing the active ingredients tetrachlorvinphos and methoprene. The reporter indicated that she applied the spray to her ~4.5 month-old, 5 pound, male Chihuahua and to her ~4.5 month-old, 5 pound female Chihuahua four days prior to initial contact with the registrant. The reporter indicated that her male Chihuahua vomited and was not eating after product application and then died later that same day. At the time of initial contact, the reporters female Chihuahua was suffering from vomiting, bloody diarrhea and anorexia. The female dog had been bathed with a hand dishwashing soap two days prior to initial contact. The reporter was advised that there are numerous possible causes for the described symptoms. A necropsy was recommended to determine an underlying cause for the male dogs death and immediate veterinary evaluation was recommended for the female dog. On follow-up call, one day later, the reporter indicated that the female dog died yesterday just as they were getting ready to take it to the veterinarian. The reporter declined a necropsy on both of her dogs. 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