Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-5203

2. Registrant Information.

Registrant Reference Number: ProPharma Group case:# 1-49204015

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.

02-AUG-17

5. Location of incident.

Country: UNITED STATES

Prov / State: INDIANA

6. Date incident was first observed.

31-JUL-17

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: HARTZ ULTRA ONESPOT GUARD FLEA EGG & FLEA LARVAE TREATMENT FOR CATS

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

---

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

Domestic Shorthair

4. Number of animals affected

3

5. Sex

Male

Female

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

8

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 - Vocalizing

• Skin
  • Symptom - Hair loss

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Anorexia

• Nervous and Muscular Systems
  • Symptom - Ataxia
  • Symptom - Difficulty getting up

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

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

1-49204015 - The reporter, a pet owner, indicated his cats were exposed to an insecticidal spot-on product containing the active ingredient (S)-methoprene. Approximately four days before the day of initial contact with the registrant, the reporter indicated he applied the product to his three cats who were 7-years-old, 8-pounds each, 2 female and 1 male, and of the domestic shorthair breed. All of the cats developed the symptoms of hair loss, lethargy, vocalizing, not eating, ataxia and difficulty getting up within 24 hours of application. All three died within one to three days before the day of initial contact and had already been buried. The reporter was advised that the product has little to no toxicity for mammals and the symptoms and death are unexpected. No additional 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