Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2015-1320

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-40093123

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.

30-MAR-15

5. Location of incident.

Country: UNITED STATES

Prov / State: WASHINGTON

6. Date incident was first observed.

05-MAR-15

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.       PMRA Submission No.       EPA Registration No. 2596-140

Product Name: UltraGuard Plus Flea/Tick Spray for Cats

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration .07 %
  • TETRACHLORVINPHOS
    • Guarantee/concentration 1.08 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Hartz Flea and Tick Collar

• Active Ingredient(s)
  • (S)-METHOPRENE
  • TETRACHLORVINPHOS
    • Unknown

---

7. b) Type of formulation.

Liquid

Other (specify)

Impregnated flea and tick collar

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

Medical Professional

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 )

10

7. Weight (provide a range if necessary )

15.4

lbs

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

• General
  • Symptom - Lethargy
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Anorexia

• Blood
  • Symptom - Anemia
  • Symptom - Blood urea nitrogen increased
  • Specify - elevated bun
  • Symptom - Hypocalcemia

• Liver
  • Symptom - Elevated liver enzymes

• Blood
  • Symptom - Hyponatremia
  • Symptom - Other
  • Specify - hypochloremia

• Skin
  • Symptom - Hair loss

• Blood
  • Symptom - Other
  • Specify - Low Chloride

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?

Treatment / Traitement

17. Provide any additional details about the incident

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

1-40093123 - The reporter, a veterinarian, indicated that a cat was exposed to an insecticidal spray containing the active ingredient tetrachlorvinphos and methoprene and to a registrant flea and tick collar containing the active ingredient tetrachlorvinphos and possibly methoprene. The reporter was not able to provide an EPA registration number, bar code number or a full name for the flea collar so the exact active ingredients cannot be determined. The reporter indicated that the pet owner applied the flea spray and the flea collar to his 10-year-old, 15.4 pound, male domestic shorthair cat either ten or eleven days prior to initial contact with the registrant and two or three days later the cat presented to the clinic anorexic, lethargic and with hair loss around the collar site. Blood work revealed severe anemia (hematocrit 9.9%), elevated BUN (67) (BUN high normal is 36) with low normal creatinine, markedly elevated ALT (3168) (ALT high normal is 130), low sodium (142) (sodium low normal is 150) and low chloride (107) (Chloride low normal is 112). The cat was hospitalized at the clinic on intravenous fluids and treated with Denamarin, amoxicillin, vitamin B complex and vitamin K. The cat passed away in the hospital the following day. The reporter performed an in-house necropsy on the cat and did not find any gross abnormalities. The body was not submitted to a pathologist for evaluation but the reporter had saved a section of the liver for possible toxicological evaluation. Information for submission of the liver samples was sent to the reporter but at this time it is unknown if the samples have been submitted. No additional 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

Status update: Liver samples were submitted to a pathologist at the (name) Veterinary Diagnostic Laboratory by the treating veterinarian for histological examination. Pathologist diagnosis: Liver, multifocal, centrilobular and bridging hepatocellular necrosis. Discussion provided by pathologist; "The laboratory values provided with this submission indicated that this cat was severely anemic. The histologic pattern of necrosis in this liver is consistent with that caused by hypoxia due to decreased oxygen carrying capacity of the blood." No additional information is available.