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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2800

2. Registrant Information.

Registrant Reference Number: PROSAR 1-22346298

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: TEXAS

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. 2596-147

Product Name: Ultraguard One Spot Flea Egg and Larvae Treatment for Cats and Kittens

  • Active Ingredient(s)
      • Guarantee/concentration 2.9 %

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

Product Name: Adams Flea and Tick Shampoo

  • Active Ingredient(s)

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 Ultraguard product was applied to two cats the evening of 4/21/10. One cat was bathed in a non-company flea and tick shampoo (Adams Flea and Tick Shampoo) when the owner returned from work to find it experiencing a reaction.

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

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed


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

Unknown / Inconnu

11. List all symptoms


  • General
    • Symptom - Lethargy
    • 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

1-22346298: The reporter, an animal owner, notified the registrant on 4/22/10 of the death of her 18 month old female cat after flea and tick drops containing the active ingredient Methoprene had been applied. According to the reporter, she had applied the product to her two cats the night of 4/21/10. She then went to work, and came home to find one cat lethargic and laying in the litter box. The reporter bathed the symptomatic cat ¿¿¿ first with just water and then with Adams Flea and Tick Shampoo. After bathing the cat lay ¿¿¿lifeless? in the bottom of the sink, took a few labored breaths and then died. The other cat never developed any symptoms. During the 4/22 call, the company sponsored necropsy program was discussed with the owner; the appropriate forms were faxed to the owner¿¿¿s veterinarian.

To be determined by Registrant

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


19. Provide supplemental information here