Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-0835

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-24485979

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: NEW YORK

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. 2596-83

Product Name: UltraGuard Flea Tick Collar for Cats

  • Active Ingredient(s)
      • Guarantee/concentration 14.55 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2724-504-2596

Product Name: UltraGuard Plus Drops for Cats

  • Active Ingredient(s)
      • Guarantee/concentration 3.6 %
      • Guarantee/concentration 40 %

7. b) Type of formulation.


Other (specify)


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 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

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms


  • Nervous and Muscular Systems
    • Symptom - Seizure
    • Symptom - Paralysis
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
  • 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

1-24485979- The reporter, a pet owner, indicates his animal has been exposed to two insecticidal products produced by the registrant. The first, a flea and tick collar for cats contained the active ingredient tetrachlorvinphos. The second, a topical insecticidal drop for cats contained the active ingredients etofenprox and methoprene. The pet owner reported he applied the topical drop to his seven year eight pound male domestic shorthair cat four days prior to his initial contact with the registrant. He reported he applied the collar later the same day. The caller indicated he used the same two products last year with no trouble. The pet owner indicated the day following application the animal was not acting normal but did not clarify the signs seen. He reported he removed the collar and bathed the animal. The pet owner indicates the day prior to his initial contact with the registrant that the animal became paralyzed unable to walk. The animal was refusing food and water and had a seizure which lasted as long as 30 seconds. The pet owner was advised the signs seen would be unexpected following use of these products according to the label instructions. He was advised of proper decontamination and to seek prompt veterinary assistance. On routine follow up the pet owner indicated the animal was brought to the veterinarian 9:30am the day of the initial contact with the registrant. The animal was described as comatose. The veterinarian provided unspecified treatments but the animal developed cardiac arrest and died by 7pm that day. The caller was advised the signs seen were inconsistent with the toxicity profile of the active ingredients. He was advised of registrant supported necropsy to assist in determining cause of death. No further information is available.

To be determined by Registrant

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


19. Provide supplemental information here