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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-4288

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-38141816

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.

15-AUG-14

5. Location of incident.

Country: UNITED STATES

Prov / State: MICHIGAN

6. Date incident was first observed.

08-AUG-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.       PMRA Submission No.       EPA Registration No. 2596-170

Product Name: Ultraguard Plus Home Spray

  • Active Ingredient(s)
    • D-PHENOTHRIN
      • Guarantee/concentration .4 %
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration 1 %
    • PYRIPROXYFEN
      • Guarantee/concentration .015 %

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: Res. - In Home / Rés. - à l'int. maison

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

Other

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Longhair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

  • 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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-38141816 - The reporter, the roommate of a pet owner, indicated that her roommates two cats were exposed to an insecticidal home spray containing the active ingredients phenothrin, piperonyl butoxide and pyriproxyfen. The reporter stated that the product was applied in one room in their apartment one week prior to initial contact with the registrant to treat an active flea infestation. The following day the roommates 1-year-old, male domestic longhair cat (Subform III #1) was found dead in the room. The reporter indicates that her roommates 6-year-old, male domestic shorthair cat (Subform III #2) has been paralyzed for the last few days and at the time of the initial call appears as though he is dying. During the phone call the reporter indicated that the cat had died. The reporters cat was also not doing well; its gums were white, it was not eating and it was lethargic. The reporter was advised that the product contains a very low concentration of active ingredients and the described symptoms are not consistent with use of the product. The reporter was further advised that the described symptoms may be secondary to flea bite anemia. A necropsy was recommended to help determine an underlying cause. Veterinary care was recommended for the reporters cat. On follow-up call, three days later, the reporter indicated that she did not seek veterinary care for her cat due to limited finances but the cat seems to be getting better. 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

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Paralysis
  • 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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-38141816 - The reporter, the roommate of a pet owner, indicated that her roommates two cats were exposed to an insecticidal home spray containing the active ingredients phenothrin, piperonyl butoxide and pyriproxyfen. The reporter stated that the product was applied in one room in their apartment one week prior to initial contact with the registrant to treat an active flea infestation. The following day the roommates 1-year-old, male domestic longhair cat (Subform III #1) was found dead in the room. The reporter indicates that her roommates 6-year-old, male domestic shorthair cat (Subform III #2) has been paralyzed for the last few days and at the time of the initial call appears as though he is dying. During the phone call the reporter indicated that the cat had died. The reporters cat was also not doing well; its gums were white, it was not eating and it was lethargic. The reporter was advised that the product contains a very low concentration of active ingredients and the described symptoms are not consistent with use of the product. The reporter was further advised that the described symptoms may be secondary to flea bite anemia. A necropsy was recommended to help determine an underlying cause. Veterinary care was recommended for the reporters cat. On follow-up call, three days later, the reporter indicated that she did not seek veterinary care for her cat due to limited finances but the cat seems to be getting better. 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