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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-0916

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-36155886

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-FEB-14

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

07-FEB-14

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. 26489      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Plus Flea/Tick Drops for Dogs/Puppies Under 30 lbs.

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

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

17

lbs

8. Route(s) of exposure

Skin

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

  • Skin
    • Symptom - Skin sensitivity
  • Nervous and Muscular Systems
    • Symptom - Abnormal posture
    • Specify - would arch up and stiffen their backs

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.

No

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

1-36155886 - The reporter, a pet owner, indicated that his two dogs were exposed to an insecticide containing the active ingredients permethrin and methoprene. The reporter applied the product to his 12 pound, male dog (Subform III #1) and to his 8 pound, male dog (Subform III #2) two days prior to initial contact with the registrant. When applying the product the reporter used of the contents of the applicator on one of his dogs and the other of the contents on his other dog. Two days after product application the reporter noticed that both of his dogs would arch up and stiffen their backs as if a nerve was stimulated when he pet the application area. Neither dog seemed to be in pain. The reporter bathed both of his dogs with a hand dish washing soap. Veterinary care was recommended for any severe or persistent symptoms. On follow-up call, three days later, the reporter indicated that the symptoms lasted for a period 3 days and then spontaneously resolved without medical intervention. 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

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

Unknown

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

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

11. List all symptoms

System

  • Skin
    • Symptom - Skin sensitivity
  • Nervous and Muscular Systems
    • Symptom - Abnormal posture
    • Specify - would arch up and stiffen their backs

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.

No

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

1-36155886 - The reporter, a pet owner, indicated that his two dogs were exposed to an insecticide containing the active ingredients permethrin and methoprene. The reporter applied the product to his 12 pound, male dog (Subform III #1) and to his 8 pound, male dog (Subform III #2) two days prior to initial contact with the registrant. When applying the product the reporter used of the contents of the applicator on one of his dogs and the other of the contents on his other dog. Two days after product application the reporter noticed that both of his dogs would arch up and stiffen their backs as if a nerve was stimulated when he pet the application area. Neither dog seemed to be in pain. The reporter bathed both of his dogs with a hand dish washing soap. Veterinary care was recommended for any severe or persistent symptoms. On follow-up call, three days later, the reporter indicated that the symptoms lasted for a period 3 days and then spontaneously resolved without medical intervention. 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