Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-4295

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-38142277

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.

15-AUG-14

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

14-AUG-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. Unknown

Product Name: UltraGuard One Spot (non-specific)

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

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7. b) Type of formulation.

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

Unknown

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

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

<=30 min / <=30 min

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Loss of coordination
  • Specify - off balance

• Gastrointestinal System
  • Symptom - Salivating excessively

• Nervous and Muscular Systems
  • Symptom - Difficulty walking
  • Symptom - Unresponsive

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

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

1-38142277 - The reporter, a pet owner, indicated that her two cats were exposed to an insecticidal spot-on product containing the active ingredient methoprene. At the time of the initial call the reporter no longer had product packaging and could not provide the full name of the product, the bar code number or registration number for the product but the reporter thought the name was Ultraguard One spot. The reporter applied the product to her 7 pound, female cat (Subform III #1) and to her 10 pound female cat (Subform III #2) one day prior to initial contact with the registrant and 13 seconds after application they were both foaming at the mouth and off balance. The reporter also indicates that at some point she could not wake the cats and had to shake them violently to wake them. The reporter indicated that she took both cats to the veterinarian where they were given some unidentified medication and fluids. At the time of the initial call the cats were still recovering. The reporter was advised that the one-spot product contains an insect growth regulator which has little to no toxicity in mammals but with ingestion of the product transient drooling may be seen due to the poor taste. 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

Moderate

19. Provide supplemental information here

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 )

Unknown

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Loss of coordination
  • Specify - wobbly

• Gastrointestinal System
  • Symptom - Salivating excessively

• Nervous and Muscular Systems
  • Symptom - Unresponsive

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

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

1-38142277 - The reporter, a pet owner, indicated that her two cats were exposed to an insecticidal spot-on product containing the active ingredient methoprene. At the time of the initial call the reporter no longer had product packaging and could not provide the full name of the product, the bar code number or registration number for the product but the reporter thought the name was Ultraguard One spot. The reporter applied the product to her 7 pound, female cat (Subform III #1) and to her 10 pound female cat (Subform III #2) one day prior to initial contact with the registrant and 13 seconds after application they were both foaming at the mouth and off balance. The reporter also indicates that at some point she could not wake the cats and had to shake them violently to wake them. The reporter indicated that she took both cats to the veterinarian where they were given some unidentified medication and fluids. At the time of the initial call the cats were still recovering. The reporter was advised that the one-spot product contains an insect growth regulator which has little to no toxicity in mammals but with ingestion of the product transient drooling may be seen due to the poor taste. 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

Moderate

19. Provide supplemental information here