Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-1290

2. Registrant Information.

Registrant Reference Number: ProPharma Group case:# 1-47133932

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.

14-FEB-17

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

10-FEB-17

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. 2596-126

Product Name: HARTZ ULTRAGUARD FLEA & TICK SPRAY FOR CATS

• Active Ingredient(s)
  • TETRACHLORVINPHOS
    • Guarantee/concentration 1.08 %

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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).

1-47133932 - The reporter indicated she applied the product to her 3-month-old, male cat of unknown breed and weight by spraying it on her hands first, then rubbing the product all over the cat on his abdomen, back, legs, neck and head.

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

Unknown

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.25

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

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Seizure

• General
  • Symptom - Vocalizing

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

1-47133932 - The reporter, a pet owner, indicated her cat was exposed to an insecticidal spray containing the active ingredient tetrachlorvinphos. Four days before the day of initial contact with the registrant, the reporter applied the product to her 3-month-old, male cat of unknown weight and breed. An unknown amount of time after application, but on the same day, the cat started vocalizing and developed seizures. The reporter consulted with a veterinarian who advised her to bathe the cat, but the cat died before this could be done. The reporter indicated her neighbor took care of the cats body, so a necropsy was not offered. The reporter was advised that this is not an expected reaction to proper application of the product. Condolences were offered to the reporter. No additional 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