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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-6351

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-35364892

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.

29-OCT-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

27-OCT-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. 29282      PMRA Submission No.       EPA Registration No.

Product Name: Ultraguard Pro Flea/Tick Drops for Dogs/Puppies Over 30 lbs.

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

7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Golden Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

65

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Drooling
    • Symptom - Mouth Irritation
    • Specify - Oral ulcer
  • Skin
    • Symptom - Peeling skin
    • Symptom - Burns (superficial)
    • Specify - width of the tongue

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-35364892 - The reporter, a veterinarian, indicated that a dog was exposed to an insecticidal product containing the active ingredients permethrin and methoprene. One and a half days prior to initial contact with the registrant a 1-year-old, 65 pound, female, Golden Retriever got into a kitchen drawer and bit into the applicator. The dog is now presenting at the clinic drooling excessively and on exam the reporter found a superficial burn across the width of the tongue with some skin sloughing. The reporter was advised that the product is not a corrosive and would not be expected to cause oral burns. It was recommended that she look to other possible causes such as the chewing of an electrical cord for the described symptoms. No further information is available.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Moderate

19. Provide supplemental information here