Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-6836

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-35451451

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.

07-NOV-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

07-SEP-13

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. 25381      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Plus Flea & Tick Collar for Cats & Kittens

• Active Ingredient(s)
  • (S)-METHOPRENE
  • TETRACHLORVINPHOS

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7. b) Type of formulation.

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Longhair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1.5

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Skin
  • Symptom - Other
  • Specify - Infected skin with pus
  • Symptom - Lesion
  • Specify - Scar

• Nervous and Muscular Systems
  • Symptom - Disorientation
  • Specify - Walked into a wall

• Skin
  • Symptom - Burns (superficial)

12. How long did the symptoms last?

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

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

Yes

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Recvrd resid.effects/Rétabli séquelles

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

1-35451451 - The reporter, a pet owner, indicated that his cat was exposed to a registrant insecticidal collar containing the active ingredients tetrachlorvinphos and methoprene. The reporter indicated that the product had been applied two months prior to initial contact with the registrant. About 1 week after product application, the reporter noticed that the cat was lethargic, it walked into a wall and had pus at the collar site. The reporter removed the collar and sought veterinary care that night. The reporter indicated that the veterinarian said his cat had a chemical burn around her neck. At the veterinary clinic the cat was sedated and her neck was cleaned and treated for an infection. At the time of reporting, the cat's skin had healed with the exception of a small scar. The reporter sought veterinary bill reimbursement. 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