Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2355

2. Registrant Information.

Registrant Reference Number: PROSAR case #1-30285987

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.

29-MAY-12

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

22-MAY-12

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. 2724-504-2596

Product Name: Ultraguard Plus Drops for Cats 5 lbs and over

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration 5 %
  • ETOFENPROX
    • Guarantee/concentration 60 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2596-139

Product Name: UltraGuard Plus Flea and Tick Collar for Cats and Kittens

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration 5 %
  • TETRACHLORVINPHOS
    • Guarantee/concentration 30 %

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7. b) Type of formulation.

Liquid

Other (specify)

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).

The reporter, a pet owner, applied the topical drops to her cat and then 48 hours later she applied the collar. The next day the reported noted hair loss at the collar site, she removed the collar and then rubbed powder from the collar on the cat's face due to fleas she had seen on the cat's face.

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

Domestic Longhair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

18

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Lethargy

• Skin
  • Symptom - Hair loss

• General
  • Symptom - Death

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

1-30285987- The reporter, a pet owner, indicates her cat was exposed to a topical flea and tick product containing etofenprox and methoprene and a flea and tick collar containing Tetrachlorvinphos and methoprene. The pet owner reports applying the product to her female, 18-year-old, domestic longed haired cat 7 days prior to contacting the registrant and then 48 hours later she reports applying a flea and tick collar. The day after applying the collar the reporter noted hair loss at the collar site so the the collar was removed. The reporter then rubbed the cats face with powder from the collar due to fleas the reporter had seen on the cats face. The cat became anorexic and lethargic and the cat died 6 days after the topical product was applied and 4 days after the collar had been applied. The caller did not seek veterinary care. No additional information is known.

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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