Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-4938

2. Registrant Information.

Registrant Reference Number: 1-34713280

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.

23-AUG-13

5. Location of incident.

Country: UNITED STATES

Prov / State: KENTUCKY

6. Date incident was first observed.

22-AUG-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. 2596-140

Product Name: Ultraguard Plus Flea/Tick Spray for Cats

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration .07 %
  • TETRACHLORVINPHOS
    • Guarantee/concentration 1.08 %

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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

Unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0.27

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

<=30 min / <=30 min

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Anorexia

• Nervous and Muscular Systems
  • Symptom - Difficulty getting up

• Gastrointestinal System
  • Symptom - Inappropriate defecation

• General
  • Symptom - Death
  • Symptom - Lethargy
  • Symptom - Adipsia
  • Specify - Not drinking
  • Symptom - Vocalizing

• Nervous and Muscular Systems
  • Symptom - Other
  • Specify - lifeless

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

1-34713280 - The reporter, a pet owner, indicated that her cat was exposed to an insecticidal spray containing the active ingredients tetrachlorvinphos and methoprene. The reporter indicated that she applied the product to her three kittens one day prior to initial contact with the registrant. The reporter indicated that two of the kittens never developed any symptoms from the exposure but her 13 week old kitten that was from a different liter and who seemed not to be growing as well or playing as much as the other two kittens developed symptoms immediately after exposure: It became lifeless and was not eating or drinking. The reporter bathed the cat that day but the symptoms persisted and at the time of the initial call the kitten still looked lifeless and would intermittently meow as though it was in pain. The kitten soiled itself on the day of initial contact and was bathed again. The reporter was advised that based on the kittens poor growth and decreased energy level it may have a congenital disorder making it more sensitive to the product or it may be suffering from a severe flea infestation. It was recommended that the reporter seek immediate veterinary care. But at the end of the call the reporter indicated that the kitten had just died. 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