Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-0302

2. Registrant Information.

Registrant Reference Number: ProPharma Group case:# 1-46451299

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: UNITED STATES

Prov / State: WISCONSIN

6. Date incident was first observed.

22-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. 2596-83

Product Name: HARTZ ULTRAGUARD FLEA & TICK COLLAR FOR CATS AND KITTENS - PURPLE SAFE

• 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?

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 )

3.5

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Muscle twitching

• Skin
  • Symptom - Hair loss
  • Symptom - Other
  • Specify - fluffed hair coat

• Nervous and Muscular Systems
  • Symptom - Shaking
  • Symptom - Ataxia

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Dehydration

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

1-46451299 - The reporter, a pet owner, indicated his cat was exposed to an insecticidal collar containing the active ingredient tetrachlorvinphos. Approximately 13 days before the day of initial contact with the registrant, the reporter placed the product on his 2-year-old, 3.5 pound, female, domestic shorthair cat. Eleven days before the day of initial contact, the reporter noticed the cat was twitching, losing hair on her back, had a fluffed hair coat, shaking, ataxic, and not eating. Nine days before the day of initial contact, the reporter removed the collar from the cat. Seven days before the day of initial contact, the reporter brought the cat to the veterinarian as her symptoms were getting worse. The veterinarian noted the cat was very dehydrated and gave her IV fluids. No blood work was done. The cat died six days before the day of initial contact with the registrant. Necropsy was not offered as the cat had died several days before. No additional information was 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