Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-0430

2. Registrant Information.

Registrant Reference Number: ProPharma case: 1-42740461

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.

16-DEC-15

5. Location of incident.

Country: UNITED STATES

Prov / State: NEBRASKA

6. Date incident was first observed.

Unknown

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

• 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?

Unknown

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 )

1

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

<=30 min / <=30 min

11. List all symptoms

System

• General
  • Symptom - Death

• Liver
  • Symptom - Hepatic failure

• Eye
  • Symptom - Other
  • Specify - Whites of eyes were yellow

• General
  • Symptom - Abnormal behaviour
  • Specify - Change in personality

12. How long did the symptoms last?

Persisted until death

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

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

1-42740461 - The reporter, a pet owner, indicated that her cat was exposed to an insecticidal spray containing the active ingredient tetrachlorvinphos. The pet owner applied the product to her 1-year-old, female cat two months prior to initial contact with the registrant. Per the reporter, the cats personality changed within 30 minutes of applying the product and it never went back to normal. When asked for clarification of the personality change the reporter stated that after the product was applied the cat would no longer allow her 6-month old kittens near her. The reporter did bring her cat to the veterinarian three different times were it was diagnosed with liver failure and her eyes were noted to be yellow. The cat died one day prior to initial contact with the registrant. The reporter was advised that liver failure would not be a direct result of product use and a necropsy was recommended to determine an underlying cause. No additional 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