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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5675

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23861153

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.



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. 2596-78

Product Name: UltraGuard Flea Tick Powder for Cats

  • Active Ingredient(s)
      • Guarantee/concentration 3.3 %

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).

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/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

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Salivating excessively
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Vomiting
  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Stiffness
    • Specify - hard to touch

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

1-23861153- The reporter, a pet owner, indicates his animal were exposed to an insecticide containing the active ingredient Tetrachlorvinphos. The caller indicates he applied the product, a topical flea and tick powder, to his four one pound six month domestic shorthair/longhair cats two days prior to the initial contact with the registrant. Though the reporter indicated the animals were six months of age a one pound kitten is more consistent with a four week animal or a significantly debilitated/underweight animal. The reporter indicates within 24 hours two (Sub form III, #1) of the four animals became very ill. The animals became lethargic, began vomiting, refused food, began foaming at the mouth, and the owner indicted they were ¿¿¿hard to the touch and looked dead?. The remaining two animals were asymptomatic at the point of the initial contact with the registrant. The caller was advised of the class of the active ingredient, decontamination procedures and advised to seek prompt veterinary care due to the small stature of the animals and the severity of the signs described. This product is not labeled for use either in animals debilitated or under twelve weeks of age. On routine follow up the reporter informed the registrant the two ill animals had died. The reporter did not provide any further information.

To be determined by Registrant

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


19. Provide supplemental information here