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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3866

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-22871546

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: MICHIGAN

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. 2596-86

Product Name: UltraGuard Flea/Tick Dip for Dogs/Cats Concentrate

  • Active Ingredient(s)
      • Guarantee/concentration 1.11 %
      • Guarantee/concentration .67 %
      • Guarantee/concentration .33 %

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).

Product was applied as directed to the cat on 6/1/10; symptoms developed by the following day.

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


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


  • Nervous and Muscular Systems
    • Symptom - Coma
    • Specify - Coma-like state, unable to move
  • 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

1-22871546: The reporter called on 6/3/10 to report the death of her 7 year old female cat after the cat had been exposed to a flea and tick dip containing the active ingredients Pyrethrins, Piperonyl Butoxide, and N-octyl Bicycloheptene Dicarboximide. According to the reporter, she applied the product as directed to her cat on 6/1. On 6/2/10 the cat was found in a "coma-like state", unable to move. The reporter bathed the cat with a non-insecticidal pet shampoo, and brought the cat to a veterinarian. The cat was treated at the veterinary clinic until her death on 6/3/10; the body was still at the veterinary clinic. During the 6/3 call, the safety profile of the product was discussed. It was also discussed that the cat's death would not be expected, and an underlying medical condition may have been present. The company-sponsored necropsy program was talk about, and the reporter indicated she would obtain her veterinarian's fax number so the pertinent information could be faxed. No further communication by the reporter has been received.

To be determined by Registrant

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


19. Provide supplemental information here