Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-6331

2. Registrant Information.

Registrant Reference Number: 1-35110799

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.

01-OCT-13

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

25-SEP-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 and 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 )

0.416

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

• General
  • Symptom - Lethargy
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Anorexia

• Nervous and Muscular Systems
  • Symptom - Seizure

• Renal System
  • Symptom - Inappropriate urination

• General
  • Symptom - Weakness
  • Symptom - Hypothermia
  • Symptom - Abnormal behaviour
  • Specify - tried to jump off couch but fell on the floor

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?

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

1-35110799 - The reporter, a pet owner, indicated that her cat was exposed to an insecticidal product containing the active ingredient methoprene. The reporter applied the product to her 5-month-old, male domestic shorthaired cat 7 days prior to initial contact with the registrant. The following day the cat looked weak and tired and the day after that it was not eating or jumping. The reporter brought her cat to the veterinarian 5 days after the product had been applied. The veterinarian bathed the cat and gave it fluids. After the bath the veterinarian told the reporter that the cat had gone into shock and its body temperature was down to 95F. The cat was sent home later that day with some oral vitamins. That night the cat peed in the reporters bed and then during the night it tried to jump off the couch but it fell on the floor, had a seizure and then died. Per the reporter the kitten had fleas the entire time that she owned it. The reporter was advised that the product has little to no toxicity in mammals and the described symptoms would not be consistent with product exposure. Kittens with a large flea burden may become anemic and can present with the described symptoms. A necropsy can help determine the cause for the cats death but the reporter indicated that the cat had already been buried. 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