Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3751

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-33942253

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.

10-JUN-13

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

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.       PMRA Submission No.       EPA Registration No. 2596-78

Product Name: Ultraguard Flea/Tick Powder for Cats

• Active Ingredient(s)
  • TETRACHLORVINPHOS
    • Guarantee/concentration 3.3 %

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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

Cat / Chat

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.42

7. Weight (provide a range if necessary )

5

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

• General
  • Symptom - Death

• Blood
  • Symptom - Bleeding

• General
  • Symptom - Lethargy

12. How long did the symptoms last?

Persisted until death

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

No

14. a) Was the animal hospitalized?

No

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

1-33942253 - The reporter, a pet owner, indicated that his cat was exposed to an insecticidal powder containing the active ingredient Tetrachlorvinphos and to a non-registrant flea and tick collar with unknown active ingredients. The reporter indicated that he applied the powder to his 5-month-old, 5 pound, female kitten six hours after removing a Sergeants flea and tick collar from the cat. Within four and half hours of applying the product he noted that the cats feet and legs were wet with discolored fluid, which the reporter thought was blood. The reporter then bathed his cat but during the night the cat was lethargic and the following morning the cat was found dead. The reporter was advised that the simultaneous use of multiple flea and tick products can potentially result in an overdose of an active ingredient and should be avoided. A necropsy was recommended to help determine a cause for the cats death. 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