Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-5150

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-41688435

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.

25-AUG-15

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW YORK

6. Date incident was first observed.

22-AUG-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2596-147

Product Name: UltraGuard One Spot Flea, Egg/Larvae Treatment for Cats and 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

Unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0.33

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

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Lethargy

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

1-41688435 - The reporter, a pet owner, indicated that her seven cats were exposed to a spot-on insecticide containing the active ingredient methoprene. The reporter applied the product to her seven cats three days prior to initial contact with the registrant. The reporters 16 week old cat (Subform III #1) , 11 year old cat (Subform III #2) and her 8 year old cat (Subform III #3) stopped eating and became lethargic and the 16 week old and 11 year old cat died one day prior to initial contact with the registrant. The 8 year old cat died on the day of initial contact. One other cat was ill (symptoms not specified) at the time of the call but the reporters three remaining cats had not developed any symptoms. The reporter did not seek veterinary care for her cats. The reporter was advised that the active ingredients in the product have little to no toxicity in mammals and the described symptoms are not expected from normal use of the product. A necropsy was recommended to help determine an underlying cause for the animals death but it was declined. No additional 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

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 )

11

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

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Death
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Anorexia

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

1-41688435 - The reporter, a pet owner, indicated that her seven cats were exposed to a spot-on insecticide containing the active ingredient methoprene. The reporter applied the product to her seven cats three days prior to initial contact with the registrant. The reporters 16 week old cat (Subform III #1) , 11 year old cat (Subform III #2) and her 8 year old cat (Subform III #3) stopped eating and became lethargic and the 16 week old and 11 year old cat died one day prior to initial contact with the registrant. The 8 year old cat died on the day of initial contact. One other cat was ill (symptoms not specified) at the time of the call but the reporters three remaining cats had not developed any symptoms. The reporter did not seek veterinary care for her cats. The reporter was advised that the active ingredients in the product have little to no toxicity in mammals and the described symptoms are not expected from normal use of the product. A necropsy was recommended to help determine an underlying cause for the animals death but it was declined. No additional 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

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 )

8

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

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Death
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Anorexia

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

1-41688435 - The reporter, a pet owner, indicated that her seven cats were exposed to a spot-on insecticide containing the active ingredient methoprene. The reporter applied the product to her seven cats three days prior to initial contact with the registrant. The reporters 16 week old cat (Subform III #1) , 11 year old cat (Subform III #2) and her 8 year old cat (Subform III #3) stopped eating and became lethargic and the 16 week old and 11 year old cat died one day prior to initial contact with the registrant. The 8 year old cat died on the day of initial contact. One other cat was ill (symptoms not specified) at the time of the call but the reporters three remaining cats had not developed any symptoms. The reporter did not seek veterinary care for her cats. The reporter was advised that the active ingredients in the product have little to no toxicity in mammals and the described symptoms are not expected from normal use of the product. A necropsy was recommended to help determine an underlying cause for the animals death but it was declined. No additional 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