Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-0979

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-24645821

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.

08-NOV-10

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

06-NOV-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).

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 )

12

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

• Nervous and Muscular Systems
  • Symptom - Muscle tremors

• General
  • Symptom - Lethargy
  • Symptom - Biting
  • Specify - biting at sking
  • Symptom - Fever

• Nervous and Muscular Systems
  • Symptom - Ataxia

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

Unknown

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

1-24645821- The reporter, a veterinary technician, indicates exposure of a patient to an insecticide containing the active ingredient permethrin. The caller stated a pet owner applied the product, a topical flea and tick drop labeled for use only on dogs, to their twelve year female domestic shorthair cat three days prior to the initial contact with the registrant. The animal had begun having muscle tremors one day after application. It was not indicated when the animal had presented to the clinic but it was reported that the veterinarian had addressed the observed signs with intravenous fluids, diazepam, and propofol. The animal was reported also to have developed a mild fever (unspecified). The veterinary technician was advised concentrated canine pyrethrin/pyrethroid spot-on type products can result in significant problems if inappropriately used on cats. She was informed of proper decontamination, treatment and prognosis in such circumstances. On routine follow up it was indicated the animal was much improved. It was reported the veterinary clinic was having some difficulty obtaining standard therapeutic agents use in treatment of these cases and had to resort to high doses of diazepam to address tremors. As a result the animal was ¿¿¿wobbly and ataxic? on follow up. The veterinary technician also indicated they had been concerned about owner compliance in the treatment of the animal after it had been sent home. 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