Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-4977

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-31807981

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.

16-OCT-12

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

13-OCT-12

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. 29930      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard One Spot Flea Egg/Larva Treatment for Cats/ Kittens

• Active Ingredient(s)
  • (S)-METHOPRENE

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7. b) Type of formulation.

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 )

8

7. Weight (provide a range if necessary )

9

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

• Skin
  • Symptom - Red skin
  • Symptom - Hair loss
  • Symptom - Other
  • Specify - hard skin

• General
  • Symptom - Fever
  • Symptom - Polydipsia
  • Specify - Increased drinking

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?

No

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

1-31807981 - The reporter, a pet owner, indicated that her cat was exposed to an insecticidal product containing the active ingredient methoprene. The reporter indicated that the product was applied to her 8-year-old, 9 pound male domestic shorthair four days prior to initial contact with the registrant. The following day the reporter noticed that there was fur loss at the application site and it was red. The reporter bathed her cat with a non-insecticidal cat shampoo but at the time of initial contact the affected area was larger and the skin had become hard. The reporter indicated that she is currently seeking veterinary care. The veterinarian called the registrant on the same day and indicated that the cat had a fever and was drinking excessive amounts of fluid. The veterinarian was advised that dermal irritation is not expected but the cat may have sensitivity to the product; symptomatic and supportive care was recommended. On follow-up call, one day later, to the veterinary clinic a female staff member indicated that the cat was treated for an infected wound. 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

Moderate

19. Provide supplemental information here