Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-6279

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-24410828

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-OCT-10

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

12-OCT-10

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. 2596-126

Product Name: UltraGuard Flea Tick Cat Spray 8 fl oz

• Active Ingredient(s)
  • 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).

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

Siamese

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

13

7. Weight (provide a range if necessary )

20

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>1 wk <=1 mo / > 1 sem < = 1 mois

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Respiratory System
  • Symptom - Difficulty Breathing

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

• General
  • Symptom - Vocalizing
  • 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

1-24410828- The reporter, a pet owner, indicates his animals have been exposed to an insecticide containing the active ingredient tetrachlorvinphos. The pet owner indicated he applied the product, a topical flea and tick spray for cats, to his thirteen year twenty pound female Siamese cat (Sub-form III, #1) two weeks prior to the initial contact with the registrant. Twelve days following application the pet owner states the animal became lethargic, gasped for air, was unable to move, became ataxic and vocalized. He reports the animal died following the development of these signs but did not specify precisely when. The pet owner stated he also applied the product to his two year fifteen pound male Manx cat (Sub-form III, #2) the day prior to the initial contact with the registrant. The animal developed ataxia, vocalized, and was unable to move at an indeterminate time frame following the exposure, but he did state the animal died within four hours of application. The pet owner did not seek veterinary assistance for either animal. He did not report any fist aid for either animal. The pet owner was advised this was inconsistent with use of the product as labeled. He was advised of registrant supported necropsy to assist in determining the cause of death in his animals. It is unclear if the reporter availed himself of this program as he had no established relationship with a veterinary clinic which could assist in specimen submission. No further information is available.

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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

Manx

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2

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 - Ataxia

• General
  • Symptom - Vocalizing

• Nervous and Muscular Systems
  • Symptom - Recumbent

• 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

1-24410828- The reporter, a pet owner, indicates his animals have been exposed to an insecticide containing the active ingredient tetrachlorvinphos. The pet owner indicated he applied the product, a topical flea and tick spray for cats, to his thirteen year twenty pound female Siamese cat (Sub-form III, #1) two weeks prior to the initial contact with the registrant. Twelve days following application the pet owner states the animal became lethargic, gasped for air, was unable to move, became ataxic and vocalized. He reports the animal died following the development of these signs but did not specify precisely when. The pet owner stated he also applied the product to his two year fifteen pound male Manx cat (Sub-form III, #2) the day prior to the initial contact with the registrant. The animal developed ataxia, vocalized, and was unable to move at an indeterminate time frame following the exposure, but he did state the animal died within four hours of application. The pet owner did not seek veterinary assistance for either animal. He did not report any fist aid for either animal. The pet owner was advised this was inconsistent with use of the product as labeled. He was advised of registrant supported necropsy to assist in determining the cause of death in his animals. It is unclear if the reporter availed himself of this program as he had no established relationship with a veterinary clinic which could assist in specimen submission. No further information is available.

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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