Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5493

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-24090066

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.

13-SEP-10

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

29-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?

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 )

14

7. Weight (provide a range if necessary )

5.8

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

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

• Gastrointestinal System
  • Symptom - Anorexia
  • Symptom - Weight loss

• Nervous and Muscular Systems
  • Symptom - Ataxia
  • Symptom - Other
  • Specify - "nerve damage"

• 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?

Yes

14. b) How long was the animal hospitalized?

1

Week(s) / Semaine(s)

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

1-24090066- The reporter, a pet owner, indicates her animal was exposed to an insecticide containing the active ingredient methoprene. The reporter indicated she had applied the product to her fourteen year 5.8 pound female domestic shorthair cat one and one half months prior to her initial contact with the registrant. She reports four days following application the animal developed loss of balance, paralysis, weight loss, and lack of appetite. The animal was brought to her veterinarian and the owner was told the animal had nerve damage. The owner stated the animal was hospitalized for one week and discharged. She did not indicate treatments provided or recommended after discharge. She did not indicate a diagnosis or diagnostics performed. The owner reported the animal was better until the morning of the initial contact with the registrant. She reported the animal was found in her shower and brought in to the bed room where she was laid on the floor. One hour later the animal was found dead. The caller was advised the signs seen, outcome and time line were all inconsistent with what might be expected following exposure to the product. She was advised all of the registrants product carry labeling discouraging use of product in dogs and cats over ten years of age. The reporter was advised of registrant supported necropsy to assist in determining cause of death. The reporter indicated she would not pursue necropsy. 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