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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-0867

2. Registrant Information.

Registrant Reference Number: Prosar 1-21195288

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: WISCONSIN

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 12/28/2009.

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 Shorthair

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

<=30 min / <=30 min

11. List all symptoms


  • Nervous and Muscular Systems
    • Symptom - Ataxia
    • Symptom - Abnormal posture
    • Specify - "Unable to hold head up"
  • 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?

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

1-21195288: A reporter (cat owner) called on 12/30/2009 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 cat was bathed with the product on 12/28/2009. Following the bath, the cat was placed on a towel and fell over. The reporter wrapped him in a towel. Later on 12/28/2009, the cat was unable to hold his head up. By 12/29/2009, the cat appeared more responsive and was walking around. The cat was evaluated by a veterinarian. Because the cat had improved, a recommendation was made to rinse the cat with water and keep it warm with a heating blanket. The reporter took the cat home and fed it water and kitten milk with a dropper. The cat started to look ill again on 12/29/2009 and was found dead on 12/30/2009. The reporter was advised that a necropsy should be considered to determine the cause of the cat's death as the signs described are not expected with product use. No further information was obtained.

To be determined by Registrant

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


19. Provide supplemental information here