Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3913

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-26694526

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.

01-JUL-11

5. Location of incident.

Country: UNITED STATES

Prov / State: OHIO

6. Date incident was first observed.

01-JUL-11

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

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

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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

unknown

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.24

7. Weight (provide a range if necessary )

3.5

lbs

8. Route(s) of exposure

Skin

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 - Lethargy

• Nervous and Muscular Systems
  • Symptom - Ataxia

• General
  • Symptom - Vocalizing

• Nervous and Muscular Systems
  • Symptom - Confusion

• 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

1-26694526- The reporter, a pet owner, indicated her animals had been exposed to an insecticide containing the active ingredient tetrachlorvinphos and methoprene. The pet owner indicated she had applied the product to two 11.75 week 3.5 pound cats the day prior to her initial contact with the registrant. The pet owner had also treated the animals an oral anti-parasitic containing the active ingredient piperazine the same day. The pet owner indicated the one cat whose sex she could identify as female (Subform III, #1) had developed lethargy ataxia, vocalization and confusion since application. The second animal whose sex she could not identify (Subform III, #2) had developed lethargy had confusion since application. The pet owner was advised to seek veterinary assistance. She was advised the worming medication piperazine has been observed to elicit neurologic signs even at labeled therapeutic doses. On follow up the pet owner indicated the female animal had died. The remaining animal was asymptomatic. Its symptoms had resolved the same day as her initial contact. No veterinary assistance was obtained. 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

Unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0.24

7. Weight (provide a range if necessary )

3.5

lbs

8. Route(s) of exposure

Skin

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 - Licking

• Nervous and Muscular Systems
  • Symptom - Confusion

12. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 h

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

Fully Recovered / Complètement rétabli

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

1-26694526- The reporter, a pet owner, indicated her animals had been exposed to an insecticide containing the active ingredient tetrachlorvinphos and methoprene. The pet owner indicated she had applied the product to two 11.75 week 3.5 pound cats the day prior to her initial contact with the registrant. The pet owner had also treated the animals an oral anti-parasitic containing the active ingredient piperazine the same day. The pet owner indicated the one cat whose sex she could identify as female (Subform III, #1) had developed lethargy ataxia, vocalization and confusion since application. The second animal whose sex she could not identify (Subform III, #2) had developed lethargy had confusion since application. The pet owner was advised to seek veterinary assistance. She was advised the worming medication piperazine has been observed to elicit neurologic signs even at labeled therapeutic doses. On follow up the pet owner indicated the female animal had died. The remaining animal was asymptomatic. Its symptoms had resolved the same day as her initial contact. No veterinary assistance was obtained. 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

Moderate

19. Provide supplemental information here