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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-0859

2. Registrant Information.

Registrant Reference Number: Prosar 1-21234561

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: ILLINOIS

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. 2596-124

Product Name: UltraGuard Flea/Tick Conditioning Shampoo for Cats 12 fl oz

  • Active Ingredient(s)
      • Guarantee/concentration .109 %
      • Guarantee/concentration .151 %

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).

The product was applied to the cat on 12/29/2009 and 12/30/2009. NOTE: The product is not labeled for daily use.

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

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms


  • General
    • Symptom - Lethargy
  • Liver
    • Symptom - Elevated liver enzymes
  • Blood
    • Symptom - Hyperglycemia
  • General
    • Symptom - Death

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?


Day(s) / Jour(s)

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

1-21234561: A reporter (cat owner) called on 01/05/2010 to report the exposure of her cat to a flea and tick shampoo containing the active ingredients Allethrin and NOBD. According to the reporter, the product was applied to the cat and immediately rinsed off on 12/29/2009. The reporter then read the directions that the product should be left on for a period of time, and the reporter reapplied the product as directed on the label. The reporter saw another flea on 12/30/2009 and used the product again. On 12/31/2009, the cat became lethargic and was taken to the veterinarian for evaluation of progressing signs. The veterinarian determined that the cat had very elevated liver enzymes and hyperglycemia. The cat was hospitalized through 01/01/2010 and received unspecified treatment. The cat died on 01/01/2010 at the veterinary clinic. The reporter was advised that the signs described are not expected, even following more frequent use of the product than recommended on the label. Occasionally an animal may have an unexpected sensitivity to an ingredient in the product, but the signs described are more likely from something unrelated to product use. The company's reimbursement policy was discussed. No further information was obtained. NOTE: The product is not labeled for daily use.

To be determined by Registrant

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


19. Provide supplemental information here