Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-6335

2. Registrant Information.

Registrant Reference Number: 1-35166302

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-OCT-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

06-OCT-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. 25922      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Flea/Tick Drops for Dogs/Puppies Over 30 lbs

• Active Ingredient(s)
  • 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

Unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

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

<=30 min / <=30 min

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Inappropriate defecation
  • Symptom - Salivating excessively

• Respiratory System
  • Symptom - Panting

• Skin
  • Symptom - Itchy skin
  • Symptom - Bleeding

• Nervous and Muscular Systems
  • Symptom - Trembling

• General
  • Symptom - Hiding
  • Symptom - Abnormal behaviour

• Nervous and Muscular Systems
  • Symptom - Muscle twitching

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

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

1-35166302 - The reporter, a pet owner, indicated that her cat was exposed to a dog spot-on insecticide containing the active ingredient permethrin. The reporter applied the product to her cat and shortly after application the cat licked the site. Twenty minutes later the cat defecated on the stove and was salivating and panting. The reporter was advised that per package labeling this product is only meant for dogs and should not be applied to cats. Bathing with a non-insecticidal soap was recommended followed by immediate veterinary care. On follow-up call, two days later, the reporter indicated that due to limited resources she did not seek veterinary care. The reporter stated that now her cat had been scratching at her neck making it bleed, it was hiding and acting strange and its paws were twitching. Veterinary care was again recommended. 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

Moderate

19. Provide supplemental information here