Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3778

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-23413250

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.

12-JUL-10

5. Location of incident.

Country: UNITED STATES

Prov / State: WASHINGTON

6. Date incident was first observed.

12-JUL-10

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

Domestic Longhair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

5

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

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

11. List all symptoms

System

• Skin
  • Symptom - Pale mucous membrane colour

• General
  • Symptom - Dehydration
  • Symptom - Hypothermia

• Cardiovascular System
  • Symptom - Bradycardia

• Renal System
  • Symptom - Other
  • Specify - "renal disease" unspecified

• General
  • Symptom - Death

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

1-23413250- The reporter, a veterinarian, calls to indicate exposure of one of his patients to a pesticide containing the active ingredient S-methoprene. The caller indicates a five year male ten pound domestic longhair cat had the product applied by its owner two days prior to the initial contact with the registrant. The animal had presented to the veterinarian today with newly developed signs of pale mucus membranes, dehydration, hypothermia, and bradycardia. The veterinarian was advised of the active ingredient and low order of mammalian toxicity. The caller was advised to wash the animal with a non-insecticidal shampoo, treat symptomatically, and work the animal up for unrelated causes for the animal¿s illness. On routine call back one of the clinic staff informed the registrant the animal had died. The animal had been diagnosed and died as a result of an unspecified renal disease according to the reporter. 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