Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-5727

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-32104775

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.

20-NOV-12

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

19-NOV-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)

---

PMRA Registration No. 25922      PMRA Submission No.       EPA Registration No.

Product Name: Ultraguard Plus Flea Tick Drops for Dogs Puppies Over 30 pounds

• Active Ingredient(s)
  • PERMETHRIN

---

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 Longhair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

8.6

lbs

8. Route(s) of exposure

Unknown

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

• Nervous and Muscular Systems
  • Symptom - Tail twitching
  • Symptom - Abnormal gait
  • Symptom - Trembling
  • Symptom - Seizure

• Gastrointestinal System
  • Symptom - Fecal incontinence
  • Symptom - Drooling
  • Symptom - Foaming at mouth

• General
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Lethargy

• Skin
  • Symptom - Pale mucous membrane colour

• Blood
  • Symptom - Anemia

• General
  • Symptom - Parasitism
  • Specify - flea infestation

• Nervous and Muscular Systems
  • Symptom - Unresponsive
  • Specify - non-responsive

• General
  • Symptom - Hypothermia

12. How long did the symptoms last?

Persisted until death

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?

1

Day(s) / Jour(s)

15. Outcome of the incident

Died

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1 32104775 The reporter, a pet owner, indicated that his two cats were exposed to a dog spot on insecticide containing the active ingredient permethrin. The reporter indicated that he applied the product to his two dogs two days prior to initial contact with the registrant. The product was never applied to the affected cats but the cats do sleep with the dogs. The dogs have not had any symptoms from the exposure. One day after product application his 4 year old, female, 8.6 pound, domestic longhaired cat (Subform III #1) started twitching her tail and was walking low to the ground. The reporter rinsed this cat with warm water but the following morning the cat was twitching, seizing, her teeth were chattering, she was drooling and foaming at the mouth and she was defecating on herself. The cat was taken to the veterinarian and by the time the owner returned their other cat a 3 year old, male, 10.6 pound domestic shorthair (Subform III #2) had the same symptoms. The reporter indicated that this cat had also vomited sometime during the night and was lying in his vomit that morning. This cat was taken to the veterinarian that same day and at the time of the initial call the reporter indicated that the veterinarian was sedating both cats and giving intravenous poison control and will observe the cats over the next three days. On follow up call one day later the reporter indicated that his 4 year-old, female cat had passed away on the same day of initial contact and his 3 year old, male cat was not yet better and was still under the care of his veterinarian. No further information is available.

---

To be determined by Registrant

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

Death

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

Male

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

10.6

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 - Vomiting
  • Symptom - Anorexia

• General
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Abnormal gait
  • Symptom - Trembling
  • Symptom - Seizure

• Gastrointestinal System
  • Symptom - Drooling
  • Symptom - Foaming at mouth

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1 32104775 The reporter, a pet owner, indicated that his two cats were exposed to a dog spot on insecticide containing the active ingredient permethrin. The reporter indicated that he applied the product to his two dogs two days prior to initial contact with the registrant. The product was never applied to the affected cats but the cats do sleep with the dogs. The dogs have not had any symptoms from the exposure. One day after product application his 4 year old, female, 8.6 pound, domestic longhaired cat (Subform III #1) started twitching her tail and was walking low to the ground. The reporter rinsed this cat with warm water but the following morning the cat was twitching, seizing, her teeth were chattering, she was drooling and foaming at the mouth and she was defecating on herself. The cat was taken to the veterinarian and by the time the owner returned their other cat a 3 year old, male, 10.6 pound domestic shorthair (Subform III #2) had the same symptoms. The reporter indicated that this cat had also vomited sometime during the night and was lying in his vomit that morning. This cat was taken to the veterinarian that same day and at the time of the initial call the reporter indicated that the veterinarian was sedating both cats and giving intravenous poison control and will observe the cats over the next three days. On follow up call one day later the reporter indicated that his 4 year-old, female cat had passed away on the same day of initial contact and his 3 year old, male cat was not yet better and was still under the care of his veterinarian. No further information is available.

---

To be determined by Registrant

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

Major

19. Provide supplemental information here