Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-4927

2. Registrant Information.

Registrant Reference Number: 1-34615511

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-AUG-13

5. Location of incident.

Country: UNITED STATES

Prov / State: MARYLAND

6. Date incident was first observed.

13-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. 2596-140

Product Name: Ultraguard Plus Flea/ Tick Spray for Cats

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

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

Female

6. Age (provide a range if necessary )

0.833

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
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Muscle spasm
  • Specify - Muscle contractions

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

1-34615511 - The reporter, a pet owner, indicated that his cat was exposed to an insecticidal spray containing the active ingredients Tetrachlorvinphos and methoprene. The reporter indicated that his girlfriend applied the spray to two 4-week-old kittens and to the mother cat one day prior to initial contact with the registrant. Hours after application of the product the female, 4 week old kitten (Subform III #1) was weak and lethargic and suffering from muscle contractions. The male 4-week-old kitten and the mother cat were asymptomatic. The kittens were bathed at that time with a hand dishwashing soap and then placed on a heating pad were they slept through the night. The following morning the female, 4-week-old kitten was found dead and the male kitten was lethargic. The reporter was advised that per package labeling the product should not be used on animals less than 12 weeks of age. Veterinary care was recommended for the male kitten. The reporter could not be reached on follow-up. 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