Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5580

2. Registrant Information.

Registrant Reference Number: 1-35014487

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.

21-SEP-13

5. Location of incident.

Country: UNITED STATES

Prov / State: IOWA

6. Date incident was first observed.

21-AUG-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. 2596-22

Product Name: UltraGuard Rid Flea/Tick Shampoo for Cats

• Active Ingredient(s)
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • Guarantee/concentration .149 %
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration .089 %
  • PYRETHRINS
    • Guarantee/concentration .045 %

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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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Siamese

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

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 - Hair loss

• General
  • Symptom - Death

• Skin
  • Symptom - Bleeding
  • Symptom - Irritated skin

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Anorexia

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?

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

1-35014487 - The reporter, a pet owner, indicated that her cat was exposed to an insecticidal shampoo containing the active ingredients pyrethrins, n-octyl bicycloheptene dicarboximide and piperonyl butoxide and to an unknown registrant flea and tick drop with unknown active ingredients. The pet owner applied the flea and tick drops to her 1-year-old, female Siamese cat one month prior to initial contact with the registrant. After application the cat had fur loss, bleeding and skin irritation at the application site which the pet owner treated with topical triple antibiotic ointment. Two weeks after the cat had been treated with the spot-on flea and tick product, the cats flea burden worsened, so the reporter shampooed her cat with the registrant flea and tick shampoo. After the bath, over the course of a week, the reporter stated that her cat became increasingly lethargic, stopped eating and then passed away at home. The reporter did not seek veterinary care. The reporter also stated that she had recently had 26 cats in her home but was now down to only 9 cats and all of them are chronically infested with fleas. The reporter was advised that some cats are sensitive to the spot-on product and can develop hair loss and dermal irritation at the application site after exposure. But progressive lethargy, anorexia and death would not occur 3 weeks after exposure to a spot-on product nor would these symptoms be expected from exposure to the flea and tick shampoo. There are numerous possible causes for the described symptoms, including a severe flea burden, and without pre-mortem or post mortem diagnostics the cause for the cats death is unknown. 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