Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-5249

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-27431784

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.

15-SEP-11

5. Location of incident.

Country: UNITED STATES

Prov / State: INDIANA

6. Date incident was first observed.

14-SEP-11

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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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2596-151

Product Name: UltraGuard Flea Tick Drops for Dogs Puppies

• Active Ingredient(s)
  • D-PHENOTHRIN
    • Guarantee/concentration 85.7 %

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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

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.166

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Difficulty getting up
  • Symptom - Muscle weakness

• General
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Muscle tremors

• Respiratory System
  • Symptom - Tachypnea

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

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

1-27431784- The reporter, a veterinarian, indicated a patient had presented following exposure to two insecticides. The first contained the active ingredient methoprene the second contained phenothrin. The reported the twelve week female domestic shorthair cat had presented 24 hours following the application of the methoprene only product. The pet owner had indicated the animal had demonstrated signs within 12 hours of application which included tachypnea, down unable to rise, muscle weakness, lethargy, and muscle tremor. The pet owner had stated they had applied the phenothrin product to a dog in the house and the kitten had been suspected of ¿cuddling with the dog and possibly grooming the product from the dog. The veterinarian was advised concentrated canine pyrethrin/pyrethroid spot-on type products can result in significant problems when cats are exposed. The caller was advised of decontamination and standards of care. On follow up a representative of the clinic had indicated the animal had died. No further information was provided.

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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