Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3931

2. Registrant Information.

Registrant Reference Number: Prosar 1-19095081

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.

08-JUL-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)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Flea/Tick Dip for Dogs/Cats Concentrate 12 fl oz

• Active Ingredient(s)
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • Guarantee/concentration 1.11 %
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration .67 %
  • PYRETHRINS
    • Guarantee/concentration .33 %

---

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 2 cats and a dog on 07/07/2009. A non-specific flea and tick drop was also applied to the cats on the same day.

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

Unknown breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.92

7. Weight (provide a range if necessary )

5

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
  • Symptom - Muscle twitching

• Respiratory System
  • Symptom - Dyspnea
  • Specify - "Gasp breathing"

• General
  • Symptom - Other
  • Specify - Apparently "died" before coming back to life
  • 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?

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

1-19095081: A reporter (pet owner) called on 07/08/2009 to report the exposure of her 2 cats and 1 dog to a flea and tick dip containing the active ingredients Pyrethrins, NOBD, and Piperonyl Butoxide. According to the reporter, the product was used on 07/07/2009 on both cats and the dog. A non-specific flea and tick drop was also applied to the cats on 07/07/2009. Both cats developed seizures the night of product application. The reporter bathed both cats with Dawn dish soap. cat #1 (1st Subform III) "died" the morning of the report. Cat #2 (2nd Subform III) was still having seizures at the time of the report. The dog was asymptomatic. The reporter was advised that the signs described are not expected with routine product use. The reporter was encouraged to find a veterinarian and take the symptomatic cat there immediately. Necropsy was recommended for Cat #1. Five hours later, the reporter called again to say that Cat #2 had "died." The reporter stated that she would call some veterinary clinics to set up necropsy on the cats. Fifteen minutes later, the reporter called again to say that Cat #1 is actually now twitching and "gasp breathing" and Cat #2 is standing up, breathing, and occasionally twitching. The reporter was advised to take both cats to the veterinarian immediately. Multiple follow up attempts were unsuccessful. No further information was obtained.

---

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

Cat / Chat

3. Breed

Unknown breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.75

7. Weight (provide a range if necessary )

3

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 - Other
  • Specify - "Died" before coming back to life

• Nervous and Muscular Systems
  • Symptom - Muscle twitching

• 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?

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

1-19095081: A reporter (pet owner) called on 07/08/2009 to report the exposure of her 2 cats and 1 dog to a flea and tick dip containing the active ingredients Pyrethrins, NOBD, and Piperonyl Butoxide. According to the reporter, the product was used on 07/07/2009 on both cats and the dog. A non-specific flea and tick drop was also applied to the cats on 07/07/2009. Both cats developed seizures the night of product application. The reporter bathed both cats with Dawn dish soap. Cat #1 (1st Subform III) "died" the morning of the report. Cat #2 (2nd Subform III) was still having seizures at the time of the report. The dog was asymptomatic. The reporter was advised that the signs described are not expected with routine product use. The reporter was encouraged to find a veterinarian and take the symptomatic cat there immediately. Necropsy was recommended for Cat #1. Five hours later, the reporter called again to say that Cat #2 had "died." The reporter stated that she would call some veterinary clinics to set up necropsy on the cats. Fifteen minutes later, the reporter called again to say that Cat #1 is actually now twitching and "gasp breathing" and Cat #2 is standing up, breathing, and occasionally twitching. The reporter was advised to take both cats to the veterinarian immediately. Multiple follow up attempts were unsuccessful. No further information was obtained.

---

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here