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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7775

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15343115

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.

Human

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: UNITED STATES

Prov / State: MASSACHUSETTS

6. Date incident was first observed.

Unknown

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.

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2724-504-2596

Product Name: UltraGuard Plus Drops for Cats 5 lbs and Over - 2724-504-2596

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration 3.6 %
  • ETOFENPROX
    • Guarantee/concentration 40 %

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 II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Numbness

4. How long did the symptoms last?

>6 mos / > 6 mois

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

Yes

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Application

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

History:(age) male caller has been applying product to his cat for several years now. He reports that he "slowly" began developing a feeling of numbness in his hands and feet. These symptoms have been occurring for the past 1 year. Patient has been to numerous doctors and specialists. He states that "scores" of tests have been performed previously by a neurologist. The doctor discussed with patient that "bilateral CNS symptoms could be an indicative of possible metabolic toxin". Caller believes that his "flare-ups" of numbness seem to coincide or get worse when his hands come into contact with product during application to his animals. Assessment: Given the history, the symptoms you report are not related to the active ingredients of the product. The active ingredients of the product are not expected to absorb or produce systemic, or central nervous symptoms following minor dermal exposure. Because symptoms have been chronic, I would encourage you to continue to work with and consult your doctor to help determine other possible causes. Provided case number. Please have your physician call back if additional product or toxicity information is needed. Notified Lead Tox.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.