Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2750

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-30408371

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.

06-JUN-12

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

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. 26489      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Plus Flea TIck Drops for Dogs Puppies Under 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 )

2

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

• Skin
  • Symptom - Pruritus
  • Symptom - Erythema
  • Symptom - Irritated skin

12. How long did the symptoms last?

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

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

Yes

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Fully Recovered / Complètement rétabli

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

1-30408371- The reporter, a pet owner, indicates her animals was exposed to an insecticidal product containing the active ingredients methoprene and permethrin. The animals were also exposed to a second topical flea and tick preparation the pet owner could not identify. The reporter indicated she had inadvertently applied the product labeled for dogs along with a second product labeled for cats to her two year female domestic shorthair cat (Subform III, #1) two days prior to her initial call. She reports some time before her initial report and after application (not clarified) the animal had developed tremor pruritis, erythema and dermal irritation. Her second cat, a one and one half year female domestic shorthair cat (Subform III, #2) had developed erythema, pruritis, and dermal irritation. She did not describe applying the products to the second animal. The cats were at the veterinarian at the point of the initial call receiving treatment the pet owner did not describe. The product the pet owner had applied was labeled only for dogs. On follow up the pet owner stated the animals had both fully recovered under the care of their veterinarian. She was unable to describe the care.

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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

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 )

1.5

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

• Skin
  • Symptom - Erythema
  • Symptom - Pruritus
  • Symptom - Irritated skin

12. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

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

Yes

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Fully Recovered / Complètement rétabli

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

1-30408371- The reporter, a pet owner, indicates her animals was exposed to an insecticidal product containing the active ingredients methoprene and permethrin. The animals were also exposed to a second topical flea and tick preparation the pet owner could not identify. The reporter indicated she had inadvertently applied the product labeled for dogs along with a second product labeled for cats to her two year female domestic shorthair cat (Subform III, #1) two days prior to her initial call. She reports some time before her initial report and after application (not clarified) the animal had developed tremor pruritis, erythema and dermal irritation. Her second cat, a one and one half year female domestic shorthair cat (Subform III, #2) had developed erythema, pruritis, and dermal irritation. She did not describe applying the products to the second animal. The cats were at the veterinarian at the point of the initial call receiving treatment the pet owner did not describe. The product the pet owner had applied was labeled only for dogs. On follow up the pet owner stated the animals had both fully recovered under the care of their veterinarian. She was unable to describe the care.

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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