Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4155

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-16543008

Registrant Name (Full Legal Name no abbreviations): The Hartz Mountain Company

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.

19-AUG-08

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

17-AUG-08

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. 2596-79

Product Name: UltraGuard Flea and Tick Powder for Dogs

• Active Ingredient(s)
  • TETRACHLORVINPHOS
    • Guarantee/concentration 3.3 %

---

7. b) Type of formulation.

Dust

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).

The reporter applied the product, labeled for dogs, to her 13 year old cat on 8/15/2008.

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

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

13

7. Weight (provide a range if necessary )

14

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

• Respiratory System
  • Symptom - Difficulty Breathing

• Cardiovascular System
  • Symptom - Other
  • Specify - Congestive heart failure

• Respiratory System
  • Symptom - Pulmonary edema
  • Symptom - Mouth breathing
  • Symptom - Pneumonia

• Cardiovascular System
  • Symptom - Cardiac arrest

• General
  • Symptom - Death

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?

Yes

14. b) How long was the animal hospitalized?

2

Day(s) / Jour(s)

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

1-16543008: The reporter called on 08/19/2008 to report the accidental exposure of a 13 year-old cat to a topical flea and tick powder intended for canines containing the active ingredient Tetrachlorvinphos on 08/15/2008. Immediately after product application the reporter realized her mistake and thoroughly washed the cat in an oatmeal shampoo for pets. The cat was asymptomatic and the caller contacted her veterinarian who advised that the cat be brought into the clinic for treatment and observation. The cat did not develop symptoms while at the veterinary clinic overnight and at the time of the report the caller was unsure whether the cat had received IV fluids. The cat was discharged from the veterinary clinic on 08/16/2008 with oral antibiotics. The cat remained asymptomatic until 08/17/2008 when the cat developed respiratory distress and was taken to the veterinary college for treatment. A thoracic radiograph showed pneumonia and pulmonary edema. The cat developed congestive heart failure later in the day on 08/17/2008 and was treated with IV fluids and oxygen. The cat went into cardiac arrest and was resuscitated twice before arresting a third time and dying. The treating DVM at the veterinary college advised the reporter that the product was unrelated to the cat¿s signs and death. The caller was advised on 08/18/2008 that the product¿s active ingredient could be expected to cause signs related to salivation, lacrimation, urination, diarrhea, and vomiting if it had not been washed off the cat. The signs seen on 08/17/2008 were not consistent with product exposure. A recommendation was made to speak with her primary DVM and the treating DVM at the veterinary college to get further information about the actual diagnosis.

---

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here