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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-2578

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-37528392

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.

18-JUN-14

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

18-JUN-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. 18108      PMRA Submission No.       EPA Registration No.

Product Name: Hartz InControl 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?

Unknown

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

Female

6. Age (provide a range if necessary )

9

7. Weight (provide a range if necessary )

15

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Seizure
    • Symptom - Bizarre behaviour
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Vomiting
  • Renal System
    • Symptom - Inappropriate urination
  • Nervous and Muscular Systems
    • Symptom - Trembling
  • Blood
    • Symptom - Anemia
    • Symptom - Leukocytosis

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?

Treatment / Traitement

17. Provide any additional details about the incident

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

1-37528392 - The reporter, a pet owner, indicated that her dog was exposed to an insecticidal collar containing the active ingredient tetrachlorvinphos. The reporter placed the collar on her 9-year-old, 15 pound, female dog on the day of initial contact with the registrant and 3 hours later the dog had a seizure and then looked out of it and was staring into space. At the time of the initial call the reporter had already removed the collar and bathed the dog. Per the reporter the dog did not ingest any portion of the collar. The reporter was advised of symptoms to watch for with excessive exposure to the active ingredient. Veterinary care was recommended to determine an underlying cause and appropriate treatment for the seizure. On follow-up call, two days later, the reporter stated that the dog was fine and the symptoms resolved within one hour. The reporter spontaneously called back eight days after the exposure and stated that four days after the exposure her dog developed diarrhea, vomited and was having urinary accidents. The reporter was advised that described symptoms are not consistent with three hour dermal contact to the product. The reporter was further advised that the delayed onset in symptoms is not consistent with exposure to the product. Veterinary care was recommended to determine an underlying cause and appropriate treatment. 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