Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2747

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-30366980

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.

04-JUN-12

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

04-JUN-12

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. 25655      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Flea and Tick Spray for Cats (Canada)

• Active Ingredient(s)
  • TETRACHLORVINPHOS

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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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

unknown breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

15

lbs

8. Route(s) of exposure

Skin

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

• Skin
  • Symptom - Irritated skin

• Gastrointestinal System
  • Symptom - Anorexia
  • Specify - decreased intake of food

• General
  • Symptom - Adipsia
  • Specify - decreased intake of water

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?

Treatment / Traitement

17. Provide any additional details about the incident

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

1-30366980-The reporter, a pet owner, indicates her cat was exposed to a topical flea and tick product containing Tetrachlorvinphos, another spot-on product with unknown active ingredients and a flea collar with unknown active ingredients. The pet owner reports applying all of these products to her male, 2-year-old, cat 12 hours prior to contacting the registrant. The morning after applying the products the reporter noted irritated skin and a decreased intake of food and water. Registrant recommended bathing the cat using a non-insecticidal shampoo or a hand-dishwashing detergent and decreasing usage of topical flea and tick products on the elderly animal. The product is not labeled for use on animal above 10 years of age and not concurrent with other topical flea and tick products. Reporter did not return registrants follow-up call. No additional information is known.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Minor

19. Provide supplemental information here