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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7752

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15119426

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.


5. Location of incident.


Prov / State: ALABAMA

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Plus Drops for Cats 5 lbs and Over - EPA 2724-504-2596

  • Active Ingredient(s)
      • Guarantee/concentration 3.5 %
      • Guarantee/concentration 40 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


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?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Longhair

4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


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


  • General
    • Symptom - Death
  • Gastrointestinal System
    • Symptom - Salivating excessively
  • Nervous and Muscular Systems
    • Symptom - Difficulty getting up
  • General
    • Symptom - Weakness
    • Symptom - Vocalizing

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


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

Owner applied the drops to his cat on 6-22-07. The cat was seen licking himself and was then salivating less than 60 minutes. Throughout the day the cat seemed weak, unable to stand up and was vocalizing/meowing real loud. He took him to the regular Veterinarian 6-23-07 for treatment for Flea bite anemia and reaction to the product and then to an ER Veterinarian for further care over the weekend. Cat passed away at the ER Vet in the morning on 6-25-07. According to the caller, he did not see any CNS symptoms or dermal symptoms. Caller does not know what treatments or exact diagnosis was made as he has all this info in his paperwork that he is mailing to Hartz today. (Caller originally called Hartz to ask for the address to mail his Vet bill to.) Assessment: Discussed with the caller the information will be added to document the case for Hartz. Sympathized with the caller on the loss of his cat.

To be determined by Registrant

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


19. Provide supplemental information here