Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-3188

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16153413

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-MAY-08

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

15-MAY-08

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. 2596-84

Product Name: UltraGuard Flea and Tick Collar for Large Dogs White

• Active Ingredient(s)
  • TETRACHLORVINPHOS
    • Guarantee/concentration 14.55 %

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7. b) Type of formulation.

Other (specify)

Treated 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).

The reporter applied the product about 1 week prior to the call.

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

Dog / Chien

3. Breed

Pit Bull Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.5

7. Weight (provide a range if necessary )

40

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Diarrhea
  • Symptom - Anorexia
  • Symptom - Salivating excessively

• General
  • Symptom - Death

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

1-16153413: The reporter called on 5/16/08 to report he had applied a flea and tick collar containing the active ingredient Tetrachlorvinphos to his 6 month old dog about 1 week prior to the call. The dog had vomited the day prior to the call (5/15), so the reporter had removed the collar. According to the reporter, at the time of the call the dog had developed loose stool and had become anorexic. The safety profile of the product was discussed. A recommendation was made to bathe the dog in a non-medicated pet shampoo, and to seek veterinary care if the symptoms persisted or worsened. The reporter called back about 11 hours later. The reporter had been giving the dog Pedialyte for hydration. The dog had begun to get up and drink, so the reporter had planned to take him to a veterinarian the next day if the dog did not improve. However, the dog had passed away about 1 hour prior to the call. The reporter also revealed additional symptoms of diarrhea and muscle weakness that the dog had developed subsequent to earlier symptoms of vomiting and increased salivation (seen 5/14 or 15). Company sponsored necropsy and cholinesterase testing was discussed but the dog had already been buried.

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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