Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2724

2. Registrant Information.

Registrant Reference Number: Prosar 1-18984658

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.

29-JUN-09

5. Location of incident.

Country: UNITED STATES

Prov / State: TENNESSEE

6. Date incident was first observed.

07-JUL-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.

Product Name: Phenothrin-based non-specific Ultraguard Flea/Tick Drops for Dogs

• Active Ingredient(s)
  • D-PHENOTHRIN
    • Unknown

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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 06/28/2009.

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

Pomeranian

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

9.7

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

• Nervous and Muscular Systems
  • Symptom - Seizure

• General
  • Symptom - Weakness
  • Symptom - Pale mucous membrane colour
  • Symptom - Dehydration
  • Symptom - Hypothermia

• Respiratory System
  • Symptom - Coughing

• Nervous and Muscular Systems
  • Symptom - Fainting

• Blood
  • Symptom - Leukocytosis

• Respiratory System
  • Symptom - Pulmonary edema

• General
  • Symptom - Death

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?

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

1-18984658: A reporter (veterinarian) called on 06/29/2009 to report the exposure of a dog to a flea and tick product containing the active ingredient Phenothrin. According to the reporter, the product was applied to the dog on 06/28/2009. An unknown time following product application, the dog developed lethargy and had a seizure. The owner called the veterinarian who recommended bathing the dog and having it evaluated the following day. The morning of the report, the dog was weak and the owner bathed the dog to remove the product. On presentation to the reporter, the dog was weak, had pale mucous membranes, was dehydrated, hypothermic, having brief seizures, coughing and fainting. A complete blood count revealed a slightly elevated white blood cell count. Blood could not be obtained for a chemistry profile. The dog had been treated with dextrose, dexamethasone S.P., IV fluids, and was being warmed. X-rays of the chest were within normal limits. The dog's heartworm status was unknown. The reporter was advised that pyrethroid toxicity can manifest as seizures/tremors, but the other signs described are not consistent with product exposure. A recommendation was made to consider shock, heartworm disease, or other toxins as a cause for the signs. The methocarbamol dose was provided and the reporter was encouraged to continue symptomatic and supportive care while ruling out other causes for the signs. On follow up, the reporter stated that the dog developed pulmonary edema and died. The reporter was provided the company's necropsy program information. 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