Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4167

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-16508433

Registrant Name (Full Legal Name no abbreviations): The Hartz Mountain Company

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.

11-AUG-08

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

06-AUG-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. 25621      PMRA Submission No.       EPA Registration No.

Product Name: 2 in 1 Flea and Tick Collar for Cats

• Active Ingredient(s)
  • 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).

The caller applied two different types of 2 in 1 flea and tick collars to her three cats. The collars were put on the cats on 8/3/2008

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 )

8

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

Unknown / Inconnu

11. List all symptoms

System

• Skin
  • Symptom - Hair loss
  • Symptom - Lesion
  • Specify - Dermal sores on neck

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

Unknown/Inconnu

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

1-16508433: The reporter called on 8/11/2008, to report exposure of her three cats to flea collars containing the active ingredient Tetrachlorvinphos. According to the reporter, the flea collars were placed on her three cats on 8/3/2008. The first cat (subform III #1) developed hair loss and dermal sores at the neck where the collar was placed.. The second cat (subform III #2) developed hair loss at the neck where the collar was placed. The third cat (subform III #3) developed watery eyes and a nasal discharge. The collars were removed from the cats 3 to 4 days after they were originally put on due to the development of symptoms. The safety profile of the product was discussed in that the symptoms described would not be expected. A recommendation was made to bathe the cats in a non-insecticidal shampoo and warm water for 5 to 10 minutes. Follow-up attempt was unsuccessful, no further information was provided.

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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

Male

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

10

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

Unknown / Inconnu

11. List all symptoms

System

• Skin
  • Symptom - Hair loss
  • Symptom - Lesion
  • Specify - Dermal sores on neck

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

Unknown/Inconnu

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

1-16508433: The reporter called on 8/11/2008, to report exposure of her three cats to flea collars containing the active ingredient Tetrachlorvinphos. According to the reporter, the flea collars were placed on her three cats on 8/3/2008. The first cat (subform III #1) developed hair loss and dermal sores at the neck where the collar was placed.. The second cat (subform III #2) developed hair loss at the neck where the collar was placed. The third cat (subform III #3) developed watery eyes and a nasal discharge. The collars were removed from the cats 3 to 4 days after they were originally put on due to the development of symptoms. The safety profile of the product was discussed in that the symptoms described would not be expected. A recommendation was made to bathe the cats in a non-insecticidal shampoo and warm water for 5 to 10 minutes. Follow-up attempt was unsuccessful, no further information was provided.

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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 )

2

7. Weight (provide a range if necessary )

8

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

Unknown / Inconnu

11. List all symptoms

System

• Respiratory System
  • Symptom - Runny nose

• Eye
  • Symptom - Watery eye
  • Specify - Eye discharge

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

Unknown/Inconnu

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

1-16508433: The reporter called on 8/11/2008, to report exposure of her three cats to flea collars containing the active ingredient Tetrachlorvinphos. According to the reporter, the flea collars were placed on her three cats on 8/3/2008. The first cat (subform III #1) developed hair loss and dermal sores at the neck where the collar was placed.. The second cat (subform III #2) developed hair loss at the neck where the collar was placed. The third cat (subform III #3) developed watery eyes and a nasal discharge. The collars were removed from the cats 3 to 4 days after they were originally put on due to the development of symptoms. The safety profile of the product was discussed in that the symptoms described would not be expected. A recommendation was made to bathe the cats in a non-insecticidal shampoo and warm water for 5 to 10 minutes. Follow-up attempt was unsuccessful, no further information was provided.

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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