Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2438

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-40547950

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.

11-MAY-15

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

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. Unknown

Product Name: UltraGuard Drops for Cats (full name unknown)

• 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

Medical Professional

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 )

1

7. Weight (provide a range if necessary )

11

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Trembling

• Eye
  • Symptom - Pupil dilation

• General
  • Symptom - Lethargy

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

1-40547950 - The reporter, a veterinarian technician, indicated that a cat was exposed to a spot-on insecticide containing the active ingredient methoprene. The reporter was not able to provide a full name of the product but did indicate that per the neighbor who applied the product it was a Hartz spot-on product for cats. The pet owner did not have the product package and could not provide a bar code number or a PCP registration number to verify product identification. Per the reporter, the pet owners neighbor applied the spot-on product to the 1-year-old, 11 pound female cat 2-3 days prior to initial contact with the registrant. On presentation the cat was tremoring had dilated pupils and there were ticks noted on the cat. The active ingredient in the Canadian Hartz spot-on product for cats has little to no toxicity in mammals and the described symptoms are not consistent with exposure to that product. On follow-up call, one day later, the reporter indicated that the cat was treated with methocarbamol and fluids and then released. 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