Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5246

2. Registrant Information.

Registrant Reference Number: Prosar 1-20264359

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.

01-OCT-09

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

01-OCT-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. 2596-124

Product Name: Advanced Care 2 in 1 Flea/Tick Conditioning Shampoo for Dogs 16 fl oz

• Active Ingredient(s)
  • D-TRANS ALLETHRIN
    • Guarantee/concentration .109 %
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • Guarantee/concentration .151 %

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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 used on 2 kittens on 09/30/2009. NOTE: This product is not labeled for use on cats.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

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

2

5. Sex

Male

6. Age (provide a range if necessary )

0.17

7. Weight (provide a range if necessary )

0.50

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Shaking

• 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

1-20264359: A reporter (cat owner) called on 10/01/2009 to report the exposure of 2 kittens to a flea and tick shampoo containing the active ingredients d-trans-Allethrin and NOBD. According to the reporter, the product was applied to the kittens 6 hours prior to the report. The reporter awoke to find both kittens shaking. He rinsed them with water but the signs persisted. The reporter was advised that both kittens should be bathed in a mild hand dish soap and evaluated by a veterinarian if the signs do not resolve. The reporter then stated that the shaking is so intense that he did not think the kittens would survive. The reporter was advised to take the kittens to a veterinarian immediately. On follow up on 10/02/2009, the reporter stated that the kittens were taken to a veterinarian but treatment was not pursued due to cost. The kittens were brought home where they died on 10/01/2009. The reporter was advised that the product is not indicated for use on cats. A recommendation was made to consider necropsy to determine the cause of death. NOTE: This product is not labeled for use on cats.

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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