Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-6001

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-24036214

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.

06-SEP-10

5. Location of incident.

Country: UNITED STATES

Prov / State: OHIO

6. Date incident was first observed.

04-SEP-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 shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.75

7. Weight (provide a range if necessary )

3

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

• Renal System
  • Symptom - Anuria

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Muscle weakness
  • Symptom - Recumbent
  • Specify - laying in liter box
  • Symptom - Seizure
  • Symptom - Other
  • Specify - "nerve damage"

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

1-24023505- The reporter, a pet owner, calls to indicate his animal has been exposed to an insecticide containing the active ingredient methoprene. The caller states he applied the product, a topical flea drop, to his nine month three pound male domestic shorthair cat two days prior to the initial contact with the registrant. The owner stated with in four hours of application the animal became lethargic. It had not used the liter box since that point and was refusing food as well. The caller was informed use of the product according to the label would not be expected to elicit the signs seen. He was told to wash his animal with a noninsecticidal shampoo and seek prompt veterinary assistance. The reporter called back spontaneously two days later not indicating he had called prior. He recanted the history adding that the animal was his mother¿¿¿s animal. He gave the same time line and signs as the prior call adding refusal of water and lying in the liter box unable to rise with this call. The caller was given the same treatment recommendations as prior and only after the call was it realized it was the same caller as before. The caller called back spontaneously fifteen minutes later and indicated his animal had died. He stated he brought the animal to the veterinarian and was told nothing could be done for the animal. He reports he was advised to feed the animal via a dropper. The caller stated he had consulted with four veterinarians and was given similar information. The caller was advised of registrant supported necropsy to determine cause of death. The opinions conveyed by the caller are contrary to current veterinary standards of care and knowledge of toxicology of this active ingredient. The reporter called back spontaneously one more time eleven minutes later not indicating he had called prior. He indicated this time the product was applied the same day as on the prior calls and the animal developed signs developed within four hours. This time the animal had developed seizures that had persisted for four days. The animal was then brought to the Humane Society. The caller stated the DVM at the Humane Society indicated the animal had ¿¿¿nerve damage? and nothing could be done for the animal. The caller was advised of the treatment guidelines as prior and the unexpected nature of the signs seen. The caller was advised of registrant supported hair testing to determine if a pyrethroid product was used on the animal. Three hours later a call was received for a party indicating she work with a veterinary office, she requested information about hair testing. The caller stated no hair was collected and the pet owner had removed the animal from the clinic refusing treatment. Hair testing submission guidelines were provided in the event the animal presented again. It is clear this is a confused history and it is unclear how much of it is an accurate representation by 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