Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2681

2. Registrant Information.

Registrant Reference Number: Prosar 1-18313459

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.

02-MAY-09

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

02-MAY-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. 2596-153

Product Name: UltraGuard Rid Flea/Tick Shampoo with Oatmeal for Dogs

• Active Ingredient(s)
  • D-PHENOTHRIN
    • Guarantee/concentration .27 %

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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 used on the dog on 05/01/2009.

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Chihuahua mixed breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

3.5

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Seizure

• General
  • Symptom - Death

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?

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

1-18313459: A reporter (veterinarian) called on 05/02/2009 to report the exposure of a dog to a flea and tick shampoo containing the active ingredient Phenothrin. According to the reporter, the dog was a stray and was treated with the product on 05/01/2009. The following morning, the dog had a seizure. The person caring for the dog bathed the dog twice in Dawn hand dish soap. At the time of the report, the dog was at the veterinary clinic and had experienced a seizure there as well. The reporter was advised that the signs described are not expected with routine use of the product. A recommendation was made to thoroughly decontaminate the dog and treat the seizures symptomatically. On follow up, the reporter stated that the dog died on 05/03/2009. The person caring for the dog had declined hospitalization. The reporter was advised to consider necropsy to try and determine the cause of the dog's signs. 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