Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2690

2. Registrant Information.

Registrant Reference Number: Prosar 1-18458349

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.

14-MAY-09

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

14-MAY-09

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2596-140

Product Name: UltraGuard Plus Flea/Tick Spray for Cats 8 fl oz

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration .07 %
  • TETRACHLORVINPHOS
    • Guarantee/concentration 1.08 %

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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).

The spray was applied to two cats on 05/13/2009.

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

Cat / Chat

3. Breed

Unknown breed

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0.42

7. Weight (provide a range if necessary )

Unknown

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

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?

Treatment / Traitement

17. Provide any additional details about the incident

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

1-18458349: A reporter (cat owner) called on 05/14/2009 to report the exposure of her 2 cats to a flea and tick spray containing the active ingredients Tetrachlorvinphos and Methoprene. According to the reporter, the product was applied to both cats on 05/13/2009. She came home from work on the day of the report to find Cat #1 (1st Subform III) dead and Cat #2 (2nd Subform III) lethargic, unresponsive, and ataxic. Cat #2 had been bathed prior to the report. The reporter was advised that the product is not expected to result in significant signs. The reporter was encouraged to take Cat #2 to the veterinarian to determine the cause and appropriate treatment for the signs described. The reporter was also advised to consider necropsy on Cat #1 to determine the cause of death. The reporter declined both necropsy for Cat #1 and veterinary evaluation for Cat #2. Reporter indicated she just wanted to report the incident. No further information was obtained.

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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

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Unknown breed

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0.42

7. Weight (provide a range if necessary )

Unknown

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 - Lethargy

• Nervous and Muscular Systems
  • Symptom - Unresponsive
  • Symptom - Ataxia

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Unknown

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

1-18458349: A reporter (cat owner) called on 05/14/2009 to report the exposure of her 2 cats to a flea and tick spray containing the active ingredients Tetrachlorvinphos and Methoprene. According to the reporter, the product was applied to both cats on 05/13/2009. She came home from work on the day of the report to find Cat #1 (1st Subform III) dead and Cat #2 (2nd Subform III) lethargic, unresponsive, and ataxic. Cat #2 had been bathed prior to the report. The reporter was advised that the product is not expected to result in significant signs. The reporter was encouraged to take Cat #2 to the veterinarian to determine the cause and appropriate treatment for the signs described. The reporter was also advised to consider necropsy on Cat #1 to determine the cause of death. The reporter declined both necropsy for Cat #1 and veterinary evaluation for Cat #2. Reporter indicated she just wanted to report the incident. No further information was obtained.

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To be determined by Registrant

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

Moderate

19. Provide supplemental information here