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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2956

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-26595037

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. 2596-22

Product Name: UltraGuard Rid Flea Tick Shampoo for Cats

  • Active Ingredient(s)
      • Guarantee/concentration .149 %
      • Guarantee/concentration .089 %
      • Guarantee/concentration .045 %

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

Medical Professional

2. Type of animal affected

Other / Autre

specify ferret

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

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

11. List all symptoms


  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
    • Symptom - Seizure
  • General
    • Symptom - Hyperthermia
    • Symptom - Hypothermia
    • Symptom - Death
  • Liver
    • Symptom - Elevated liver enzymes
  • General
    • Symptom - Vocalizing

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

1-26595037-The reporter, a veterinarian, called to indicate an animal had presented to him following exposure to an insecticide containing the active ingredients pyrethrins, piperonyl butoxide, and n-octyl bicycloheptene dicarboximide. The veterinarian indicated the pet owner had applied the product labeled for use on cats to a twelve week ferret two days prior to presentation to him. The primary complaint was recent onset of seizures. The veterinarian was advised the product was not labeled for use on this species. He was advised on proper decontamination, supportive care and prognosis. On follow up the veterinarian had indicated they had bathed the animal in a hand dish washing liquid three times and methocarbamol was administered. The animal had additional seizures, muscle twitching and vocalizing. The pet was administered intravenous diazepam when additional seizures were seen. The veterinarian had stated his technical staff had commented the animal seemed cold though a value was not quantified. On one additional follow up four days after the initial contact with the registrant the veterinarian stated the animal had died. The animal was additionally treated with methocarbamol and diazepam which had controlled the tremors and seizures but the animal temperature was erratic, vacillating between 106 and 95. The animal developed labored breathing and on serum chemistry the ALT was found to be 210. It was noted by the veterinarian this was above the normal value for the species. The animal¿s remains were taken home by the owners, necropsy was declined. No further information was available.

To be determined by Registrant

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


19. Provide supplemental information here