Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3182

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-33756713

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.

22-MAY-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

22-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. 26491      PMRA Submission No.       EPA Registration No.

Product Name: Ultraguard One Spot Treatment for Cats/Kittens

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

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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 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 )

Unknown

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

• Respiratory System
  • Symptom - Panting

• Nervous and Muscular Systems
  • Symptom - Shakiness

• General
  • Symptom - Fever

• Respiratory System
  • Symptom - Heavy breathing

12. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

3

Day(s) / Jour(s)

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

1-33756713 - The reporter, a friend of a pet owner, indicated that her friends cat was exposed to an insecticidal product containing the active ingredient methoprene. The reporter indicated that her friend applied the product to her 2-year-old, female cat one day prior to initial contact with the registrant. At the time of initial contact the reporter indicated that a dog flea and tick product was also applied to a dog in the house on the same day but this was later denied by the pet owners veterinarian. The day after product application the reporter indicated that the cat was found shaking, breathing with increased effort and open mouthed breathing. The cat was taken to the veterinarian where it was hospitalized for 3 days treated for a fever, treated with intravenous fluids and some unknown shot that the reporter indicated was an antidote. The reporter was advised that the product has little to no toxicity in mammals but cats that may have been exposed to a dog product could develop symptoms as described. Bathing with a non-insecticidal shampoo was recommended and hair testing to determine if the cat may have been exposed to a pyrethroid insecticide from a dog product was offered. On follow-up call, seven days later, the treating veterinarian indicated that the toxicology report on the hair testing was positive for methoprene, permethrin and pentobarbital. The treating veterinarian indicated that initially she treated the cat with symptomatic therapy but symptoms continued so she gave lipid therapy and the cat recovered shortly after lipid therapy treatment. 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