Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-0301

2. Registrant Information.

Registrant Reference Number: ProPharma Group case:# 1-46455623

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.

05-DEC-16

5. Location of incident.

Country: CANADA

Prov / State: NEW BRUNSWICK

6. Date incident was first observed.

30-NOV-16

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. Unknown

Product Name: HARTZ ULTRAGUARD PLUS FLEA & TICK COLLAR FOR CATS&KITTENS-WHITE COLLAR

• 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 Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

12

lbs

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

• Skin
  • Symptom - Irritated skin

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

Unknown

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

1-46455623 - The reporter, a pet owner, indicated his cat was exposed to an insecticidal collar containing the active ingredient tetrachlorvinphos and (S)-methoprene. Approximately 10 days before the day of initial contact with the registrant, the reporter placed the product on his 3-year-old, 12-pound, female, domestic shorthair cat. An unknown number of days after the application, the cat developed skin irritation at the site of the collar. The reporter removed the collar on an unknown date and the cat was fine. The reporter was advised this is not an expected reaction to the product and the pet may have an individual sensitivity to an ingredient in the product. 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

Minor

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 )

5

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• General
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Anorexia
  • Symptom - Weight loss

• Nervous and Muscular Systems
  • Symptom - Bizarre behaviour

• Skin
  • Symptom - Jaundice

• Renal System
  • Symptom - Urine discoloration

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?

Unknown

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

1-46455623 - The reporter, a pet owner, indicated his cat was exposed to an insecticidal collar containing the active ingredient tetrachlorvinphos and (S)-methoprene. Approximately 10 days before the day of initial contact with the registrant, the reporter placed the product on his 5-year-old, 10-pound, female, domestic shorthair cat. Five days before the day of initial contact, the cat stopped eating, lost weight, started hiding, and her skin and urine were yellow. The reporter removed the collar from the cat at this point. Four days before the day of initial contact, the reporter sought veterinary care for the cat where she was diagnosed with liver damage. On an unknown date the cat had a heart attack and died and was cremated. The reporter was advised that this is not an expected reaction to application of the product. Necropsy was not offered as the cat was already cremated. 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