Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3787

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23552284

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.

23-JUL-10

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

23-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).

The reporter used the product on her animal. She also reports using a home insecticidal spray and home fogger, but was unable to provide product identification. The formulation and active ingredients are unknown for the two subsequent products.

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

Persian

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

12

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

10. Time between exposure and onset of symptoms

>1 wk <=1 mo / > 1 sem < = 1 mois

11. List all symptoms

System

• General
  • Symptom - Death

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

1-23552284- The reporter, a pet owner, calls to indicate her animal has been exposed to an insecticide containing the active ingredient s-methoprene. The caller indicates she applied the product to four cats three weeks prior to the initial contact with the registrant. The caller also claims she had used a home insecticidal spray and a home fogger during the following three weeks but was unsure of when they were used. The subsequent products were not identified as the reporter did not have the labels. The active ingredients/formulation for these products are unknown. The reporter indicated the animals were out of the home when they were used. Rentry unspecified. The caller indicated she found her five year twelve pound female Persian cat (SubformIII, #1) dead the morning of her initial contact with the registrant. No signs preceded the animal¿s death, it did not see a veterinarian, and had been buried without a necropsy. She reports a second cat, an eleven year twelve pound male domestic shorthair (Subform III, #2), has seen the veterinarian for the signs of weight loss and anemia. The caller did not specify the onset or the time frame of the veterinary visit but did indicate the animal had been treated with injectable iron, injectable antibiotics and sent home with oral versions of both medications. The animal has failed to respond to the treatment provided. One more cat, a six year female eight pound Persian cat (Subform III, #3), has developed hair loss of unspecified onset. The caller states this sign is related to a flea bite hypersensitivity. One remaining animal remains asymptomatic. The caller was advised the well tolerated active ingredient is in very low concentration and would not be expected to yield the signs or outcome seen. The caller was advised of a registrant supported necropsy program, and advised to work with her veterinarian to determine etiology and treatment for the remaining animals. 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

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

Male

6. Age (provide a range if necessary )

11

7. Weight (provide a range if necessary )

12

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Weight loss

• Blood
  • Symptom - Anemia

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?

Unknown

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

1-23552284- The reporter, a pet owner, calls to indicate her animal has been exposed to an insecticide containing the active ingredient s-methoprene. The caller indicates she applied the product to four cats three weeks prior to the initial contact with the registrant. The caller also claims she had used a home insecticidal spray and a home fogger during the following three weeks but was unsure of when they were used. The subsequent products were not identified as the reporter did not have the labels. The active ingredients/formulation for these products are unknown. The reporter indicated the animals were out of the home when they were used. Rentry unspecified. The caller indicated she found her five year twelve pound female Persian cat (SubformIII, #1) dead the morning of her initial contact with the registrant. No signs preceded the animal¿s death, it did not see a veterinarian, and had been buried without a necropsy. She reports a second cat, an eleven year twelve pound male domestic shorthair (Subform III, #2), has seen the veterinarian for the signs of weight loss and anemia. The caller did not specify the onset or the time frame of the veterinary visit but did indicate the animal had been treated with injectable iron, injectable antibiotics and sent home with oral versions of both medications. The animal has failed to respond to the treatment provided. One more cat, a six year female eight pound Persian cat (Subform III, #3), has developed hair loss of unspecified onset. The caller states this sign is related to a flea bite hypersensitivity. One remaining animal remains asymptomatic. The caller was advised the well tolerated active ingredient is in very low concentration and would not be expected to yield the signs or outcome seen. The caller was advised of a registrant supported necropsy program, and advised to work with her veterinarian to determine etiology and treatment for the remaining animals. 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

Persian

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

8

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Skin
  • Symptom - Hair loss

12. How long did the symptoms last?

Unknown / Inconnu

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

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

1-23552284- The reporter, a pet owner, calls to indicate her animal has been exposed to an insecticide containing the active ingredient s-methoprene. The caller indicates she applied the product to four cats three weeks prior to the initial contact with the registrant. The caller also claims she had used a home insecticidal spray and a home fogger during the following three weeks but was unsure of when they were used. The subsequent products were not identified as the reporter did not have the labels. The active ingredients/formulation for these products are unknown. The reporter indicated the animals were out of the home when they were used. Rentry unspecified. The caller indicated she found her five year twelve pound female Persian cat (SubformIII, #1) dead the morning of her initial contact with the registrant. No signs preceded the animal¿s death, it did not see a veterinarian, and had been buried without a necropsy. She reports a second cat, an eleven year twelve pound male domestic shorthair (Subform III, #2), has seen the veterinarian for the signs of weight loss and anemia. The caller did not specify the onset or the time frame of the veterinary visit but did indicate the animal had been treated with injectable iron, injectable antibiotics and sent home with oral versions of both medications. The animal has failed to respond to the treatment provided. One more cat, a six year female eight pound Persian cat (Subform III, #3), has developed hair loss of unspecified onset. The caller states this sign is related to a flea bite hypersensitivity. One remaining animal remains asymptomatic. The caller was advised the well tolerated active ingredient is in very low concentration and would not be expected to yield the signs or outcome seen. The caller was advised of a registrant supported necropsy program, and advised to work with her veterinarian to determine etiology and treatment for the remaining animals. 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

Minor

19. Provide supplemental information here