Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3947

2. Registrant Information.

Registrant Reference Number: Prosar 1-19236571

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.

20-JUL-09

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW YORK

6. Date incident was first observed.

17-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. 2596-140

Product Name: UltraGuard Plus Flea/Tick Spray for Dogs 16 fl oz

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration .07 %
  • TETRACHLORVINPHOS
    • Guarantee/concentration 1.08 %

---

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 07/16/2009.

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

Springer Spaniel

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

10

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

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Salivating excessively
  • Symptom - Anorexia

• Nervous and Muscular Systems
  • Symptom - Difficulty getting up

• General
  • Symptom - Adipsia

• Nervous and Muscular Systems
  • Symptom - Muscle tremors

• General
  • Symptom - Vocalizing
  • Specify - barking and howling

• Gastrointestinal System
  • Symptom - Diarrhea

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Recumbent
  • Specify - "Laying on floor

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?

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

1-19236571: A reporter (dog owner) called on 07/20/2009 to report the exposure of his dog to a flea and tick spray containing the active ingredients Methoprene and Tetrachlorvinphos. According to the reporter, the product was applied to the dog on 07/16/2009. By the morning of 07/17/2009, the dog was salivating, not eating, and having trouble getting up. The dog's signs worsened over the next couple of days, and at the time of the report the dog was also not drinking and was having tremors. The reporter was advised that the signs described would not be expected with normal product use. The reporter was advised that he can bathe the dog but that the dog should see a veterinarian immediately. On follow up, the reporter stated that the dog was bathed twice and taken to the veterinarian after the initial report. The dog was treated with IV fluids and atropine and was sent home with another injection of atropine and more fluids for the reporter to administer. At the time of follow up, the reporter said the dog was not doing well and was lying on the floor howling and barking. The reporter was again advised that these signs are not expected with product use. A recommendation was made to have the dog re-evaluated by a veterinarian given the persistent signs. The reporter called back on 07/27/2009 to report that the dog developed diarrhea on 07/21/2009 and died at home later that day. The dog was not re-evaluated by a veterinarian. 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