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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-1291

2. Registrant Information.

Registrant Reference Number: ProPharma Group case:# 1-47197733

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.

21-FEB-17

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

Unknown

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: HARTZ ULTRAGUARD PLUS FLEA & TICK 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: 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).

1-47197733 - The product is intended to be used in the home, not on an animal.

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Pit Bull Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1.5

7. Weight (provide a range if necessary )

61

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Death
  • Respiratory System
    • Symptom - Laboured breathing
    • Symptom - Pneumonia

12. How long did the symptoms last?

Persisted until death

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

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

1-47197733 - The reporter, a veterinarian, indicated a dog was exposed to an insecticidal home spray containing the active ingredients phenothrin, piperonyl butoxide, and pyriproxyfen. Approximately seven days before the day of initial contact with the registrant, the reporter indicated a 61-pound, 1.5-year-old, male, pit bull terrier dog was accidently sprayed with the product, and presented to the reporter today with labored breathing. The reporter was advised that the product might cause respiratory irritation which should resolve within 30 minutes of getting fresh air, but the severity of the dogs symptom would not be expected. On follow-up call one day later, the reporter indicated that radiographs were taken of the dog and severe pneumonia was discovered. The dog died in the clinic overnight. No additional 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