Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3058

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-30955599

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.

23-JUL-12

5. Location of incident.

Country: UNITED STATES

Prov / State: WASHINGTON

6. Date incident was first observed.

22-JUL-12

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. 2596-83

Product Name: UltraGuard Pro Flea andTick Collar for Cats Safety Release Snap

• Active Ingredient(s)
  • TETRACHLORVINPHOS
    • Guarantee/concentration 14.55 %

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7. b) Type of formulation.

Other (specify)

Collar

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

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Domestic long hair

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0.08

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

1-30955599 - The reporter, a veterinary technician, indicated two kittens were exposed to an insecticidal collar containing the active ingredient Tetrachlorvinphos. The veterinary technician reported that a collar was placed on a 1 pound 6 ounce, 4-week-old, female domestic long haired kitten (Subform III #1) and another collar was placed on a 4-week-old domestic long haired(Subform III #2) one day prior to initial contact with the registrant. The 1 pound 6 ounce kitten (Subform III #1) presented to the veterinary clinic for shaking on the day of initial contact. The other kitten (Subform III #2) was reported to have died at home and was not brought to the clinic. The veterinary technician was advised that the product is not labeled for use on animals less than 12 weeks of age. Removal of the collar, bathing the animal with a non-insecticidal shampoo and administration of methocarbamol to control shaking was recommended. On follow-up, three days later, a reporter at the clinic indicated that the collar was removed, the cat was bathed and treated with an unspecified antibiotic and with an unspecified flea treatment. According to the reporter the kitten looked better when it left the clinic. 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

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Long hair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.08

7. Weight (provide a range if necessary )

1.6

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>8 hrs <= 24 hrs / >8 h <= 24 h

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Shakiness

12. How long did the symptoms last?

Unknown / Inconnu

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

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

1-30955599 - The reporter, a veterinary technician, indicated two kittens were exposed to an insecticidal collar containing the active ingredient Tetrachlorvinphos. The veterinary technician reported that a collar was placed on a 1 pound 6 ounce, 4-week-old, female domestic long haired kitten (Subform III #1) and another collar was placed on a 4-week-old domestic long haired(Subform III #2) one day prior to initial contact with the registrant. The 1 pound 6 ounce kitten (Subform III #1) presented to the veterinary clinic for shaking on the day of initial contact. The other kitten (Subform III #2) was reported to have died at home and was not brought to the clinic. The veterinary technician was advised that the product is not labeled for use on animals less than 12 weeks of age. Removal of the collar, bathing the animal with a non-insecticidal shampoo and administration of methocarbamol to control shaking was recommended. On follow-up, three days later, a reporter at the clinic indicated that the collar was removed, the cat was bathed and treated with an unspecified antibiotic and with an unspecified flea treatment. According to the reporter the kitten looked better when it left the clinic. 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

Minor

19. Provide supplemental information here