Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-6288

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-24627191

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.

05-NOV-10

5. Location of incident.

Country: UNITED STATES

Prov / State: OREGON

6. Date incident was first observed.

03-NOV-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 )

2

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

• Eye
  • Symptom - Pupil dilation

• Respiratory System
  • Symptom - Laboured breathing

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Abnormal behaviour
  • 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

1-24627191-The reporter, a pet owner indicates her animal was exposed to an insecticide containing the active ingredient methoprene. The pet owner applied the product, a topical flea preventative labeled for use on cats, to her two cats four days before her initial contact with the registrant. The pet owner indicates her one year male ten pound domestic shorthair cat was found two days following application with dilated eyes and acting strange (not clarified). The following day the animal was observed the same but also was refusing food. The owner attempted to provide some water the animal gasped for air and expired. The second animal treated remained asymptomatic. The pet owner had buried the dead animal prior to her initial contact with the registrant. The animal had not seen the veterinarian and had no necropsy. The pet owner was advised the product would not be expected to elicit the signs seen when used according to the label. The animal that passed was likely suffering from some unrelated heath condition.

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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