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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2013-6346
2. Registrant Information.
Registrant Reference Number: 1-35256533
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.
16-OCT-135. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
16-OCT-13Product 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. 25620 PMRA Submission No. EPA Registration No. Unknown
Product Name: UltraGuard Flea/Tick Collar for Dogs
- Active Ingredient(s)
- TETRACHLORVINPHOS
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?
No
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
Boxer
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.13
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
>1 wk <=1 mo / > 1 sem < = 1 mois
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Diarrhea
- Symptom - Vomiting
- General
- Symptom - Lethargy
- Respiratory System
- Symptom - Laboured breathing
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
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
Fully Recovered / Complètement rétabli
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
1-35256533 - The reporter, a friend of the pet owner, indicated that her friends two dogs were exposed to an insecticidal collar containing the active ingredient tetrachlorvinphos. The reporter did not have product packaging and could not provide the PCP registration number for the product. Two weeks prior to initial contact with the registrant the pet owner applied the collars to her two 5-week-old, male, boxers. One of the boxers weighed 8 pounds at the time of the initial call (Subform III #1) and the other boxer weighed 7 pounds (Subform III #2). The dogs did not have any symptoms until the day of the initial call. On the day of the initial call the 8 pound dog had diarrhea, was vomiting, lethargic and was having trouble breathing. The seven pound dog was lethargic. The collars had not been chewed but the reporter thought the two dogs may have groomed each other and licked some of the powder from the other dog. At the time of the call the collars had been removed and both dogs had been bathed. The reporter was advised that per package labeling the product is only meant for dogs greater than 12 weeks of age and it is not meant to be applied to dogs that are 5 weeks old. Veterinary care was recommended for diagnosis and appropriate treatment. On follow-up call, two days later, the reporter indicted that she took her dogs to the veterinarian but it was not indicated if any treatment had been provided. Both dogs symptoms had resolved at the time of the follow-up call. 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
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
Boxer
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.13
7. Weight (provide a range if necessary )
7
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>1 wk <=1 mo / > 1 sem < = 1 mois
11. List all symptoms
System
- General
- Symptom - Lethargy
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
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
Fully Recovered / Complètement rétabli
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
1-35256533 - The reporter, a friend of the pet owner, indicated that her friends two dogs were exposed to an insecticidal collar containing the active ingredient tetrachlorvinphos. The reporter did not have product packaging and could not provide the PCP registration number for the product. Two weeks prior to initial contact with the registrant the pet owner applied the collars to her two 5-week-old, male, boxers. One of the boxers weighed 8 pounds at the time of the initial call (Subform III #1) and the other boxer weighed 7 pounds (Subform III #2). The dogs did not have any symptoms until the day of the initial call. On the day of the initial call the 8 pound dog had diarrhea, was vomiting, lethargic and was having trouble breathing. The seven pound dog was lethargic. The collars had not been chewed but the reporter thought the two dogs may have groomed each other and licked some of the powder from the other dog. At the time of the call the collars had been removed and both dogs had been bathed. The reporter was advised that per package labeling the product is only meant for dogs greater than 12 weeks of age and it is not meant to be applied to dogs that are 5 weeks old. Veterinary care was recommended for diagnosis and appropriate treatment. On follow-up call, two days later, the reporter indicted that she took her dogs to the veterinarian but it was not indicated if any treatment had been provided. Both dogs symptoms had resolved at the time of the follow-up call. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
