Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2238

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-25828131

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-APR-11

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

06-APR-11

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. 2596-84

Product Name: UltraGuard Flea Tick Collar for Large Dogs

• Active Ingredient(s)
  • TETRACHLORVINPHOS
    • Guarantee/concentration 14.55 %

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7. b) Type of formulation.

Other (specify)

Collar

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

American Bulldog

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.5

7. Weight (provide a range if necessary )

45

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Bloody stool

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

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

1-25828131- The caller, a pet owner, indicated his animal may have been exposed to an insecticidal product containing the active ingredient tetrachlorvinphos. The pet owner indicated his six month forty five pound male American Bulldog may have ingested the product (a flea and tick collar) from around its housemates neck. The exposure was reported to have taken place two days prior to the initial contact with the registrant. The pet had refused to eat the day prior t his initial contact and the day of the initial contact was demonstrating the signs of lethargy and was passing bloody fetid stool. The pet owner was advised that the signs seen were inconsistent with the toxicity profile of the active ingredient but having ingested full product the animal may be subject to a gastrointestinal obstruction due to the ingestion of the foreign object. It was advised he seek immediate veterinary assistance. On routine follow up the pet owner indicated the animal was diagnosed with Parvo viral enteritis by his veterinarian and had died secondary to that disease. The signs seen were unrelated to the exposure described.

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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