Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3749

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-33888601

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-13

5. Location of incident.

Country: UNITED STATES

Prov / State: IDAHO

6. Date incident was first observed.

31-MAY-13

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. 2596-151

Product Name: Ultraguard Flea/Tick Drops for Dogs/Puppies Over 60 lbs

• Active Ingredient(s)
  • D-PHENOTHRIN
    • Guarantee/concentration 85.7 %

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7. b) Type of formulation.

Liquid

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

Dog / Chien

3. Breed

Labrador Retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.42

7. Weight (provide a range if necessary )

40

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

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Anorexia
  • Symptom - Weight loss

• General
  • Symptom - Death

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?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

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

1-33888601 - The reporter, a veterinarian, indicated that a dog was exposed to an insecticidal spot-on product containing the active ingredient phenothrin. The reporter indicated that the pet owner applied the product to his 5 month old, 40 pound, male Labrador retriever four days prior to initial contact with the registrant and on the day of product application the dog stopped eating which then progressed to vomiting and weight loss. The reporter indicated that she thought the dog might be suffering from parvovirus as it had not received the full parvovirus vaccine series. The reporter was advised that the pet owner had applied a product to their 40 pound dog which is meant for dogs greater than 60 pounds and with overdose there is a risk for an adverse reaction. Bathing the animal with a non-insecticidal shampoo was recommended. The reporter was further advised that the described symptoms are non-specific and a complete work-up was recommended to determine a definitive cause for the animals illness. On follow-up call, two days later, a staff member at the veterinary clinic indicated that a parvovirus test on the dog was negative but the dog died at home last night. 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

Death

19. Provide supplemental information here