Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-3366

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-37691705

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.

03-JUL-14

5. Location of incident.

Country: UNITED STATES

Prov / State: MISSOURI

6. Date incident was first observed.

01-JUL-14

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. 2596-147

Product Name: Ultraguard One Spot Flea, Egg/Larvae Treatment for Cats/Kittens

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration 2.9 %

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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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Persian

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

7

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

• General
  • Symptom - Lethargy
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Anorexia

• Blood
  • Symptom - Anemia

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?

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

1-37691705 - The reporter, a pet owner, indicated that his cat was exposed to a spot-on insecticide containing the active ingredient methoprene. The reporter applied the product to his 5-year-old, 7 pound, female Persian two days prior to initial contact with the registrant to treat an active flea infestation. Either 1 or 2 days after the product was applied the cat became lethargic and was not eating or drinking. At the time of the initial call the reporter was at his veterinary clinic and the cat was receiving intravenous fluids and they were considering giving the cat a blood transfusion. The reporter was advised that the active ingredient in the product does not kill adult fleas and has little to no toxicity in mammals. Veterinary care was recommended for diagnosis and appropriate treatment of the cats symptoms. On follow-up call, four days later, the reporter indicated that her veterinarian told her that her cat was anemic from fleas. The veterinarian started a blood transfusion but the cat passed away during the transfusion. 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