Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-7268

2. Registrant Information.

Registrant Reference Number: ProPharma Group case:# 1-46068985

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.

27-OCT-16

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW YORK

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. 2596-78

Product Name: HARTZ ULTRA GUARD FLEA &TICK POWDER FOR CATS

• Active Ingredient(s)
  • TETRACHLORVINPHOS
    • Guarantee/concentration 3.3 %

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7. b) Type of formulation.

Dust

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 Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2

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

• Nervous and Muscular Systems
  • Symptom - Ataxia

• Gastrointestinal System
  • Symptom - Weight loss

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

1-46068985 - The reporter, a pet owner, indicated her cat was exposed to an insecticidal powder containing the active ingredient tetrachlorvinphos. The reporter had been applying the product weekly to her 2-year-old, female, domestic shorthair cat of unknown weight once a week for about three weeks starting at an unknown date before the day of initial contact with the registrant. Two weeks before the day of initial contact, the reporter indicated the cat had died after an unknown period of time of weight loss and ataxia. The reporter had not sought veterinary care for the cat. The reporter was advised this is not an expected reaction to the product if the label directions are followed. 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

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

12

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

• Nervous and Muscular Systems
  • Symptom - Ataxia

• Gastrointestinal System
  • Symptom - Weight loss

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

1-46068985 - The reporter, a pet owner, indicated her cat was exposed to an insecticidal powder containing the active ingredient tetrachlorvinphos. The reporter had been applying the product weekly to her 12-year-old, female, domestic shorthair cat of unknown weight once a week for about three weeks starting at an unknown date before the day of initial contact with the registrant. Two weeks before the day of initial contact, the reporter indicated the cat had died after an unknown period of time of weight loss and ataxia. The reporter had not sought veterinary care for the cat. The reporter was advised this is not an expected reaction to the product if the label directions are followed. 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

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Shorthair Angel

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

3

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

• Nervous and Muscular Systems
  • Symptom - Ataxia

• Gastrointestinal System
  • Symptom - Weight loss

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

1-46068985 - The reporter, a pet owner, indicated her cat was exposed to an insecticidal powder containing the active ingredient tetrachlorvinphos. The reporter had been applying the product weekly to her 3-year-old, female, domestic shorthair cat of unknown weight once a week for about three weeks starting at an unknown date before the day of initial contact with the registrant. The reporter indicated the last application of the product to the cat was about 1 week ago. The cat was now experiencing weight loss and ataxia. The reporter was advised this is not an expected reaction to the product if the label directions are followed, and veterinary care should be sought for the cat. A follow-up call was attempted three days after the initial contact and a voice mail was left for information on the cat. Another follow-up call was done four days after initial contact. The reporter had not gotten veterinary care for the cat who died on the day of initial contact, but she had spoken to her veterinarian who suspected the cat died of feline leukemia. Necropsy was discussed, but the cat had already been buried. 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