Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2908

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-40964258

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.

18-JUN-15

5. Location of incident.

Country: UNITED STATES

Prov / State: ILLINOIS

6. Date incident was first observed.

13-JUN-15

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)

---

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 %

---

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

Male

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

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

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Bloody stool
  • Symptom - Anorexia
  • Symptom - Other
  • Specify - eating kitty litter

• General
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Unresponsive

• General
  • Symptom - Death

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

1-40964258 - The reporter, a pet owner, indicated that his cat was exposed to a spot-on insecticide containing the active ingredient methoprene. The pet owner applied the product to his 6-year-old, 5 pound, male cat five days prior to initial contact with the registrant to treat an active flea infestation. Sometime after use of the product the cat stopped eating his food but was eating kitty litter. Just prior to the initial call the cat was unresponsive and bleeding from his rectum and 30 minutes prior to the call the cat passed away. No veterinary care had been sought. The reporter was advised that the active ingredient in the product has little to no toxicity in mammals and the described symptoms are not expected from use of the product. The reporter was further advised that severe flea bite anemia may cause the described symptoms and a necropsy was recommended to help determine the reason for the cat's death but this was declined by the reporter. No further information is available.

---

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here