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: 2011-2241

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-25879409

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. 2596-83

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)

pet collar

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

<=30 min / <=30 min

11. List all symptoms


  • Nervous and Muscular Systems
    • Symptom - Seizure
  • Gastrointestinal System
    • Symptom - Salivating excessively
  • General
    • Symptom - Lethargy
  • Respiratory System
    • Symptom - Difficulty Breathing
  • 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

1-25879409-The reporter, a pet owner, indicates his animal was exposed to two insecticidal products. The first contained the active ingredients etofenprox and methoprene, the second the active ingredient tetrachlorvinphos. The pet owner stated she applied the first product a topical flea and tick drop for cats (the etofenprox/methoprene product) to her three year eleven pound male domestic shorthair cat ten days prior to her initial contact with the registrant. The pet owner indicated the animal began drooling and foaming at the mouth immediately following application. The pet owner did nothing to address the signs the first day but the day following application she washed the product off her animal. She then decided to apply the second product, a flea and tick collar for cats, to her animal (the tetrachlorvinphos product). The animal was reported to have become lethargic the day after application (two days following the application of the topical flea and tick drops). The pet owner removed the collar and took the animal to the veterinarian. She indicted the pet had a seizure and died on the veterinarians exam table. She did not offer treatment or diagnostic information if available and indicated the animals remains had already been disposed. The veterinarian had offered a necropsy but she had declined. The pet owner was advised the signs seen would not be expected when products are used according to the label. Using multiple overlapping insecticidal is discouraged by the registrant.

To be determined by Registrant

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


19. Provide supplemental information here