Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2816

2. Registrant Information.

Registrant Reference Number: Prosar 1-18597177

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.

26-MAY-09

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

24-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. 2596-139

Product Name: UltraGuard Flea/Tick Collar for Dogs (non-specific)

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration 1.02 %
  • TETRACHLORVINPHOS
    • Guarantee/concentration 14.55 %

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7. b) Type of formulation.

Other (specify)

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 product was applied to 3 dogs on 05/23/2009.

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

Chihuahua

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

10

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

• 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

1-18597177: A reporter (dog owner) called on 05/26/2009 to report the exposure of her 3 dogs to a flea and tick collar containing the active ingredients Methoprene and Tetrachlorvinphos. According to the reporter, the product was placed on the dogs on 05/23/2009. The following morning, Dog #1 (1st Subform III) was found dead. Dog #2 (2nd Subform III) and Dog #3 (3rd Subform III) were vomiting, passing blood in the stool, having muscle tremors and were lethargic. Dog #2 and Dog #3 were evaluated by a veterinarian on an unknown date. They tested negative for Parvo virus. The collars were removed, the dogs' necks were bathed, and atropine was administered. At the time of the report, Dog #2 and Dog #3 were almost fully recovered. The reporter was advised that necropsy is the best way to determine cause of death. A recommendation was also made to consider cholinesterase testing to determine whether the product was related to the dogs' 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

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Mixed Breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.67

7. Weight (provide a range if necessary )

40

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

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Bloody stool

• Nervous and Muscular Systems
  • Symptom - Muscle tremors

• General
  • Symptom - Lethargy

12. How long did the symptoms last?

Unknown / Inconnu

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

Fully Recovered / Complètement rétabli

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

1-18597177: A reporter (dog owner) called on 05/26/2009 to report the exposure of her 3 dogs to a flea and tick collar containing the active ingredients Methoprene and Tetrachlorvinphos. According to the reporter, the product was placed on the dogs on 05/23/2009. The following morning, Dog #1 (1st Subform III) was found dead. Dog #2 (2nd Subform III) and Dog #3 (3rd Subform III) were vomiting, passing blood in the stool, having muscle tremors and were lethargic. Dog #2 and Dog #3 were evaluated by a veterinarian on an unknown date. They tested negative for Parvo virus. The collars were removed, the dogs' necks were bathed, and atropine was administered. At the time of the report, Dog #2 and Dog #3 were almost fully recovered. The reporter was advised that necropsy is the best way to determine cause of death. A recommendation was also made to consider cholinesterase testing to determine whether the product was related to the dogs' 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

Moderate

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Chihuahua

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.42

7. Weight (provide a range if necessary )

6

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

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Bloody stool

• Nervous and Muscular Systems
  • Symptom - Muscle tremors

• General
  • Symptom - Lethargy

12. How long did the symptoms last?

Unknown / Inconnu

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

Fully Recovered / Complètement rétabli

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

1-18597177: A reporter (dog owner) called on 05/26/2009 to report the exposure of her 3 dogs to a flea and tick collar containing the active ingredients Methoprene and Tetrachlorvinphos. According to the reporter, the product was placed on the dogs on 05/23/2009. The following morning, Dog #1 (1st Subform III) was found dead. Dog #2 (2nd Subform III) and Dog #3 (3rd Subform III) were vomiting, passing blood in the stool, having muscle tremors and were lethargic. Dog #2 and Dog #3 were evaluated by a veterinarian on an unknown date. They tested negative for Parvo virus. The collars were removed, the dogs' necks were bathed, and atropine was administered. At the time of the report, Dog #2 and Dog #3 were almost fully recovered. The reporter was advised that necropsy is the best way to determine cause of death. A recommendation was also made to consider cholinesterase testing to determine whether the product was related to the dogs' 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

Moderate

19. Provide supplemental information here