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Incident Report
Subform I: General Information
1. Report Type.
Update the report
Incident Report Number: 2014-0495
2. Registrant Information.
Registrant Reference Number: 2014-0495
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.
07-JAN-145. Location of incident.
Country: UNITED STATES
Prov / State: GEORGIA
6. Date incident was first observed.
06-JAN-14Product 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. 2596-22
Product Name: Advanced Care 2 in 1 Rid Flea Dog Shampoo Fresh Citrus 18 fl ounces
- Active Ingredient(s)
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- Guarantee/concentration .149 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration .089 %
- PYRETHRINS
- Guarantee/concentration .045 %
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
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
Mixed breed
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
3
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>30 min <=2 hrs / >30 min <=2 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Seizure
- General
- Symptom - Death
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
1-35910518-The reporter, a pet owner, indicated that her 4 dogs were exposed to an insecticidal shampoo containing the active ingredients pyrethrins, n-octyl bicycloheptene dicarboximide and piperonyl butoxide. The reporter bathed all 4 of her dogs with this shampoo one night prior to initial contact with the registrant. Within 2 hours of bathing the dogs the reporters 3-year-old Maltese and Poodle mixed breed dog (Subform III #1) and her 9-year-old Pomeranian (Subform III #2) were both having seizures. The reporters 3 year old Maltese and poodle mixed breed dog had seizures until 12 am when it passed away. The reporters 9-year-old Pomeranian had seizures until 2am when it passed away. Veterinary care was not sought for either dog. A third dog also had a seizure but at the time of the initial call it was doing okay. The fourth dog did not have any symptoms from the exposure. The reporter was advised that the low concentration of active ingredient in the product would not be expected to cause the described symptoms. Necropsies were recommended to help determine the underlying cause for the death 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
Status update: This third dog was a 10-year-old, female miniature Schnauzer who had seizures and was found to have increased liver enzymes. On follow-up call, 6 days after the exposure the dog was home and doing well but still had a little muscle weakness.
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Pomeranian
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
9
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>30 min <=2 hrs / >30 min <=2 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Seizure
- General
- Symptom - Death
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
1-35910518-The reporter, a pet owner, indicated that her 4 dogs were exposed to an insecticidal shampoo containing the active ingredients pyrethrins, n-octyl bicycloheptene dicarboximide and piperonyl butoxide. The reporter bathed all 4 of her dogs with this shampoo one night prior to initial contact with the registrant. Within 2 hours of bathing the dogs the reporters 3-year-old Maltese and Poodle mixed breed dog (Subform III #1) and her 9-year-old Pomeranian (Subform III #2) were both having seizures. The reporters 3 year old Maltese and poodle mixed breed dog had seizures until 12 am when it passed away. The reporters 9-year-old Pomeranian had seizures until 2am when it passed away. Veterinary care was not sought for either dog. A third dog also had a seizure but at the time of the initial call it was doing okay. The fourth dog did not have any symptoms from the exposure. The reporter was advised that the low concentration of active ingredient in the product would not be expected to cause the described symptoms. Necropsies were recommended to help determine the underlying cause for the death 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
Status update: This third dog was a 10-year-old, female miniature Schnauzer who had seizures and was found to have increased liver enzymes. On follow-up call, 6 days after the exposure the dog was home and doing well but still had a little muscle weakness.
