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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-1431

2. Registrant Information.

Registrant Reference Number: PROSAR 1-21738087

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: FLORIDA

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 a 13 year old cat and a cat of unknown age on 02/20/2010. NOTE: This product is not labeled for use on aged pets (defined by the company as older than 10 years of age).

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


  • Respiratory System
    • Symptom - Other
    • Specify - "Stopped breathing"
  • 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

1-21738087: A reporter (cat owner) called on 02/23/2010 to report the exposure of 2 cats to a flea and tick shampoo containing the active ingredients Allethrin and NOBD. According to the reporter, the product was applied to both cats on 02/20/2010 after a flea was noted on one of them. Within 30 minutes of product use, Cat #1, a 13 year old DSH, (1st Subform III) stopped breathing and died. Cat #1 was buried in the back yard. The other cat remained asymptomatic. The reporter was advised that the signs described are not expected with routine product use and other causes should be considered for the cat's death. No further information was obtained. NOTE: This product is not labeled for use on aged cats (defined by the company as older than 10 years of age).

To be determined by Registrant

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


19. Provide supplemental information here