Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-4853

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-38523403

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.

22-SEP-14

5. Location of incident.

Country: UNITED STATES

Prov / State: MARYLAND

6. Date incident was first observed.

13-SEP-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)

---

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 %

---

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

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

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration 1.02 %
  • TETRACHLORVINPHOS
    • Guarantee/concentration 14.55 %

---

7. b) Type of formulation.

Liquid

Other (specify)

Impregnated 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).

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 Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

14

lbs

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
  • Symptom - Weakness

• Gastrointestinal System
  • Symptom - Anorexia

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

1-38523403 - The reporter, a pet owner, indicated that her cat was exposed to an insecticidal spot-on product containing the active ingredient methoprene and to an insecticidal collar containing the active ingredients tetrachlorvinphos and methoprene. The pet owner applied the spot-on product to her 4-year-old, female cat, to treat an active flea infestation, seven days prior to initial contact with the registrant and the following day she applied the insecticidal collar. After the collar was applied the cat became weak, lethargic and stopped eating. Two days after the collar had been applied the cat passed away. No veterinary care was sought. The reporter was advised that simultaneous use of multiple flea and tick products is not recommended as it could result in an overdose. The reporter was further advised that the described symptoms are not expected from normal use of the product and that anemia from a severe flea infestation could cause the described symptoms. The reporter indicated that the cat did have a lot of fleas. No further information is available.

---

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here