Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5673

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23859561

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.

19-AUG-10

5. Location of incident.

Country: CANADA

Prov / State: NEWFOUNDLAND

6. Date incident was first observed.

19-AUG-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. 25922      PMRA Submission No.       EPA Registration No.

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

• Active Ingredient(s)
  • 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).

canine product applied to canine in household

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 )

2

7. Weight (provide a range if necessary )

9

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

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 - Ataxia
  • Symptom - Muscle tremors
  • Symptom - Seizure

• 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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-23859561- The reporter, a pet owner, indicates her animal had been exposed to an insecticide containing the active ingredient permethrin. The caller indicated he had applied the product, a topical flea and tick drop labeled only for dogs to his dog within the past hour. His two year eight pound female domestic shorthair cat was observed grooming the dog and had licked the product from the dog¿¿¿s coat. The caller had notes sign of ataxia, tremor, and continuous seizure at the time of the initial contact with the registrant. The caller was advised the use of concentrated canine pyrethrin/pyrethroid spot-on type products can result in significant problems if inappropriately used on cats. Ingestion of the product by the cat from the dogs coat and resultant signs should be followed by prompt veterinary care. The caller was advised of signs seen after such exposures, standard treatment protocols, and prognosis. The reporter spontaneously called the registrant back within five hours. The reporter indicated the animal had died. The veterinarian the reporter had contacted had indicated the animal needed to receive ¿¿¿a shot? within 15 minutes of exposure to be effective. As a result the owner did not bring the animal to the vet and it died. The opinion of the veterinarian conveyed by the owner is contrary to current emergency/critical care standards in veterinary medicine associated with known pyrethroid exposures in cats. 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

Death

19. Provide supplemental information here