Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-6684

2. Registrant Information.

Registrant Reference Number: ProPharma Group case#: 1-54714974

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.

19-NOV-18

5. Location of incident.

Country: UNITED STATES

Prov / State: PENNSYLVANIA

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)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2596-139

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

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration 1.02 %
  • TETRACHLORVINPHOS
    • Guarantee/concentration 14.55 %

---

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 %

---

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 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 1021-1674-2596

Product Name: HARTZ ULTRAGUARD PLUS HOME FOGGER

• Active Ingredient(s)
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • Guarantee/concentration .16 %
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration .1 %
  • PYRETHRINS
    • Guarantee/concentration .05 %
  • PYRIPROXYFEN
    • Guarantee/concentration .1 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 1021-1723-2596

Product Name: HARTZ ULTRAGUARD RID FLEA & TICK SHAMPOO FOR CATS

• Active Ingredient(s)
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • Guarantee/concentration .479 %
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration .3 %
  • PYRETHRINS
    • Guarantee/concentration .15 %

---

7. b) Type of formulation.

Liquid

Dust

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

Male

6. Age (provide a range if necessary )

13

7. Weight (provide a range if necessary )

18

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

• General
  • Symptom - Death

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

• General
  • Symptom - Hiding

• Gastrointestinal System
  • Symptom - Other
  • Specify - Decreased fecal output

12. How long did the symptoms last?

Persisted until death

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

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

1-54714974 - The reporter, a pet owner, indicates an exposure to multiple pesticide products including collars, shampoos, foggers and powders containing the active ingredients tetrachlorvinphos, (s)-methoprene, piperonyl butoxide, pyriproxyfen, N-octyl bicycloheptene dicarboximide, pyrethrins, and (S-(R*,R*))-4-Chloro-alpha-(1-methylethyl)benzeneacetic acid, cyano(3-phenoxyphenyl)methyl ester. Starting seven months before the day of initial contact with the registrant, the reporter individually applied the five different pesticide products to his 13-year-old, 18-pound, male, domestic shorthair cat. An unknown amount of time later, the cat developed anorexia, weight loss, hiding behavior, and decreased fecal output. The reporter indicated the cat died five days before the day of initial contact. No additional information is available.

---

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here