Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-6291

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-24649121

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.

08-NOV-10

5. Location of incident.

Country: UNITED STATES

Prov / State: MISSOURI

6. Date incident was first observed.

Unknown

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

Female

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

5

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Lethargy
  • 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

1-24649121- The reporter, a pet owner, indicated her animals were exposed to an insecticide containing the active ingredient methoprene. The pet owner indicted she applied the product to her two cats seven days prior to the initial contact with the registrant. The owner indicated her three year five pound female domestic shorthair cat (Subform III, #1) developed lethargy and anorexia at an unspecified interval following application. The animal was reported to have died three days following application. The pet owner reported her nine year eleven pound male domestic shorthair cat (Subform III, #2) had developed hair loss and loss of appetite within three days of application . The veterinarian had done blood tests and found everything within normal limits. The pet owner was told by the veterinarian to offer a bland diet. The pet owner at the point of initial contact had indicated the animal was still not eating well seven days following initial application. The pet owner was advised that the symptoms seen would not be expected to be seen following application of this product according to label instructions. The pet owner was urged to consider other potential causes due to the low order of toxicity of the product used. The pet owner did not respond to routine follow-up attempts.

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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 )

9

7. Weight (provide a range if necessary )

14

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 - Hair loss

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Anorexia
  • Specify - loss of appetite

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

1-24649121- The reporter, a pet owner, indicated her animals were exposed to an insecticide containing the active ingredient methoprene. The pet owner indicted she applied the product to her two cats seven days prior to the initial contact with the registrant. The owner indicated her three year five pound female domestic shorthair cat (Subform III, #1) developed lethargy and anorexia at an unspecified interval following application. The animal was reported to have died three days following application. The pet owner reported her nine year eleven pound male domestic shorthair cat (Subform III, #2) had developed hair loss and loss of appetite within three days of application . The veterinarian had done blood tests and found everything within normal limits. The pet owner was told by the veterinarian to offer a bland diet. The pet owner at the point of initial contact had indicated the animal was still not eating well seven days following initial application. The pet owner was advised that the symptoms seen would not be expected to be seen following application of this product according to label instructions. The pet owner was urged to consider other potential causes due to the low order of toxicity of the product used. The pet owner did not respond to routine follow-up attempts.

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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