Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-1958

2. Registrant Information.

Registrant Reference Number: Prosar 1-18216371

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.

23-APR-09

5. Location of incident.

Country: UNITED STATES

Prov / State: ARKANSAS

6. Date incident was first observed.

21-APR-09

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. 2596-150

Product Name: UltraGuard Plus Flea/Tick Drops Plus for Dogs/Puppies Over 60 lbs

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration 2.3 %
  • D-PHENOTHRIN
    • Guarantee/concentration 85.7 %

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7. b) Type of formulation.

Liquid

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 product was applied to the dog on 04/20/2009.

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

Shar Pei/Chow Mix

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

65

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Respiratory System
  • Symptom - Panting
  • Symptom - Respiratory distress

• Gastrointestinal System
  • Symptom - Bloody vomit

• Nervous and Muscular Systems
  • Symptom - Ataxia

• General
  • Symptom - Fever
  • Symptom - Death
  • Symptom - Other
  • Specify - Erlichia

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?

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

1-18216371: A reporter called on 04/23/2009 to report the exposure of her dog to a flea and tick product containing the active ingredients Phenothrin and Methoprene. According to the reporter, the product was applied to the dog on 04/20/2009. On 04/21/2009, the dog was found outside in a pasture with signs of panting, lethargy, vomiting blood, respiratory distress and ataxia. The dog was evaluated by a veterinarian later that same day. At that point, the dog also had a fever. Blood work was performed and the dog was diagnosed with Erlichia. She was sent home on antibiotics and steroids, and she was bathed when she got home. On 04/22/2009, the dog was again found outside in the pasture and did not come back to the house that evening for her dinner. She was found dead on 04/23/2009. The reporter was advised that the signs described are not expected with exposure to the product. Some dogs may be sensitive to the active ingredients and develop skin irritation, and much less commonly neurologic signs such as ataxia, tremors and seizures. The reporter was encouraged to consider other causes of her dog's signs including Erlichia as diagnosed by the veterinarian or any potential toxins the outdoor dog may have gotten into. No further information was obtained.

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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