Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3938

2. Registrant Information.

Registrant Reference Number: Prosar 1-19161310

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.

14-JUL-09

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

11-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. 2596-86

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 %

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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 4 cats on 07/11/2009.

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

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

13

7. Weight (provide a range if necessary )

12

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Seizure

• Gastrointestinal System
  • Symptom - Vomiting

• Eye
  • Symptom - Other
  • Specify - "Eyes were moving"

• Renal System
  • Symptom - Urinary incontinence

• 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

1-19161310: A reporter (cat owner) called on 07/14/2009 to report the exposure of her 4 cats to a flea and tick dip containing the active ingredients Pyrethrins, Piperonyl Butoxide, and NOBD. According to the reporter, the product was applied to the 4 cats with a bucket and washcloth on 07/11/2009. One hour following product application, Cat #1 (1st Subform III) developed seizures, vomited, had abnormal eye movements, urinated and died. At the time of the report, Cat #2 (2nd Subform III) was lethargic, was crying when picked up, and needed to be force fed. He was bathed with Dawn dish soap on 07/11/2009. The other 2 cats were asymptomatic at the time of the report. The reporter was advised that the signs described are not expected with product use. Necropsy was discussed as an option to try and determine the cause of death, but Cat #1 had been buried. A recommendation was made to have Cat #2 evaluated by a veterinarian. The company's reimbursement policy was reviewed. An attempt at follow up was unsuccessful, and 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

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

15

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 - Lethargy
  • Symptom - Vocalizing
  • Specify - "Cries when picked up"

• Gastrointestinal System
  • Symptom - Anorexia
  • Specify - Requires force-feeding

12. How long did the symptoms last?

Unknown / Inconnu

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

1-19161310: A reporter (cat owner) called on 07/14/2009 to report the exposure of her 4 cats to a flea and tick dip containing the active ingredients Pyrethrins, Piperonyl Butoxide, and NOBD. According to the reporter, the product was applied to the 4 cats with a bucket and washcloth on 07/11/2009. One hour following product application, Cat #1 (1st Subform III) developed seizures, vomited, had abnormal eye movements, urinated and died. At the time of the report, Cat #2 (2nd Subform III) was lethargic, was crying when picked up, and needed to be force fed. He was bathed with Dawn dish soap on 07/11/2009. The other 2 cats were asymptomatic at the time of the report. The reporter was advised that the signs described are not expected with product use. Necropsy was discussed as an option to try and determine the cause of death, but Cat #1 had been buried. A recommendation was made to have Cat #2 evaluated by a veterinarian. The company's reimbursement policy was reviewed. An attempt at follow up was unsuccessful, and 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