Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3173

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-33624355

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.

10-MAY-13

5. Location of incident.

Country: UNITED STATES

Prov / State: ALASKA

6. Date incident was first observed.

03-MAY-13

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 )

2

7. Weight (provide a range if necessary )

8.5

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

• General
  • Symptom - Death
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Anorexia

• Skin
  • Symptom - Hair loss

• Nervous and Muscular Systems
  • Symptom - Agitation

• Skin
  • Symptom - Lesion

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

1-33624355 - The reporter, a pet owner, indicated that his cat was exposed to an insecticidal product containing the active ingredient methoprene. The reporter indicated that he applied the product to his 2-year-old, female, 8.5 pound domestic short hair one week prior to initial contact with the registrant. The reported indicated that immediately after the product was applied his cat was running around and agitated. Two days after product application the cat developed hair loss at the application site. Within one week of product application the cat also stopped eating and drinking became lethargic and developed a sore at the application site. The owner attempted to force feed the cat but one day prior to initial contact the reporter indicated that his cat died at home. The reporter indicated that he did not seek veterinary care for his cat due to limited finances. The reporter was advised that the product has little to no toxicity in mammals but some animals may be sensitive to the product and dermal symptoms may develop in these animals. Bathing the cat with a non-insecticidal shampoo is recommended if any dermal sensitivity is evident and veterinary care is recommended for any severe or persistent symptoms. The reporter was further advised that there are numerous possible causes for anorexia and death but these symptoms are not consistent with product exposure. Other underlying causes for these symptoms should be ruled out. 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