Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-1957

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-29883491

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.

24-APR-12

5. Location of incident.

Country: UNITED STATES

Prov / State: OHIO

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

Male

6. Age (provide a range if necessary )

1

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

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

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Vomiting

• Nervous and Muscular Systems
  • Symptom - Lameness
  • Symptom - Difficulty walking

• Liver
  • Symptom - Other
  • Specify - impaired liver function

• Nervous and Muscular Systems
  • Symptom - Seizure

• 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

1-29883491- The reporter, a pet owner, indicated his animal was exposed to an insecticidal product containing the active ingredient methoprene. The reporter indicated he had used the topical flea preventative on his one year male fourteen pound domestic shorthair cat one year ago with no ill effects. He indicated he applied the product to the animal 3-4 weeks prior to his initial contact with the registrant. He noted vomiting within 24 of application. 3-4 days later the animal began limping which progressed to inability to use its hind limbs. The pet was taken to the veterinarian where it was given subcutaneous fluids and unknown injection and pills. The pet owner stated she was told the animals liver function was impaired. The animals mobility worsened within three days, it had a seizure and died at home. No necropsy had been performed. The pet owner was advised the signs seen and outcome seen was inconsistent with the toxicity profile of the active ingredient or the finished product. 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