Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3779

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-23399048

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.

10-JUL-10

5. Location of incident.

Country: CANADA

Prov / State: NEW BRUNSWICK

6. Date incident was first observed.

10-JUL-10

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. 29282      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Pro Flea Tick Drops for Dogs Puppies Over 30 lbs

• Active Ingredient(s)
  • (S)-METHOPRENE
  • PERMETHRIN

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7. b) Type of formulation.

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).

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

1

5. Sex

Female

6. Age (provide a range if necessary )

0.33

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Muscle tremors

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-23333048- The reporter, a pet owner, indicates her animal has been exposed to an insecticide containing the active ingredient permethrin and methoprene. The pet owner indicates her four month female domestic shorthair cat had been observed licking the product which had been applied to her dog prior. The ingestion volume was unknown and took place the day prior to the initial call. The cat was at the initial contact with the registrant demonstrating the newly developed sign of muscle tremors. The caller was advised of the signs typically seen in feline patients exposed to concentrated canine topical flea and tick preparations. She was advised of standardized treatment protocols following these exposures, the typical duration of those treatments, and prognosis. She was lastly advised to seek prompt veterinary care. The pet owner did not respond to two attempts at routine follow up. No further information is available.

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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