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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-1029

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-24990786

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.

Country: CANADA


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)

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 Long hair

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


  • Eye
    • Symptom - Pupil dilation
  • Nervous and Muscular Systems
    • Symptom - Seizure

12. How long did the symptoms last?

Unknown / Inconnu

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

Fully Recovered / Complètement rétabli

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

1-24990786- The reporter, a pet owner, indicates her animal was exposed to an insecticide containing the active ingredient tetrachlorvinphos. The pet owner indicated she bathed her five month five pound female domestic longhair cat with a non-registrant flea and tick shampoo with an unknown active ingredient the night prior to her initial contact. She then applied the registrant¿s product, a topical flea and tick powder labeled for use on cats, the morning of her initial contact with the registrant. The pet owner indicated the animal may have been grooming in effort to remove the product and had ingested it as a consequence. The pet owner indicated the animal was found 3.5 hours prior to her initial contact with the registrant with dilated eyes and in the midst of a seizure. The pet owner indicated the animal was on the way to the veterinarian with another family member. The pet owner was advised, individually, the registrant¿s product would not be expected to yield toxicity or the signs seen. When combined with other topical flea and tick products the response can be additive. The pet owner was advised to seek immediate veterinary assistance and to provide the formulation of the other unknown product. On routine callback the pet owner indicated the veterinarian had supported the animal with intravenous fluids and unknown medication. The animal had made a complete recovery. 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