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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3935

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-26938965

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. 2596-140

Product Name: UltraGuard Plus Flea Tick Spray for Cats

  • Active Ingredient(s)
      • Guarantee/concentration .07 %
      • Guarantee/concentration 1.08 %

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 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 <=2 hrs / >30 min <=2 h

11. List all symptoms


  • Nervous and Muscular Systems
    • Symptom - Ataxia
  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Adipsia
  • Renal System
    • Symptom - Urinary incontinence
  • Gastrointestinal System
    • Symptom - Fecal incontinence
  • General
    • Symptom - Death
  • Skin
    • Symptom - Pale mucous membrane colour
    • Specify - mucous membranes are pale pink
  • General
    • Symptom - Parasitism
    • Specify - peritoneal cavity contains five, tan to white, round worms, lumen of jejunum contain one similar worm, intralesional nematodes, presence of ascrid roundworms.
  • Gastrointestinal System
    • Symptom - Weight loss
    • Specify - severe emaciation
    • Symptom - Other
    • Specify - enteritis
    • Symptom - Mouth Irritation
    • Specify - stomatitis
    • Symptom - Other
    • Specify - peritonitis
  • Blood
    • Symptom - Other
    • Specify - bone marrow hyperplasia and left shift

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

1-26938965- The reporter, a pet owner, indicated her animal was exposed to an insecticide containing the active ingredients tetrachlorvinphos and methoprene. The reporter indicated she applied the product to her thirteen year female domestic shorthair cat three days prior to the initial contact wit the registrant. The reporter indicated within two hours of application the animal stopped eating and drinking and behaved as though drunk. The reporter indicated she then washed the animal with a non insecticidal shampoo. The following day the animal was reporter to have improved, but then the subsequent day the animal was again worse. The pet owner did not qualify what she meant by better then worse. The pet owner stated that day the animal was found dead on the kitchen floor. The animal was not brought to the veterinarian at any point. The pet owner did bring the animals remains to the veterinarian and submitted to the University of Illinois Veterinary Diagnostic Laboratory for necropsy. Definitive cause of death but the results included: ┐┐┐poor nutritional condition evidenced by lack of subcutaneous and visceral adipose tissue stores, and a general lack of musculature. Body wide, the fur contains numerous live and dead fleas. The mucous membranes are pale pink. The peritoneal cavity contains five, tan to white, round worms that are approximately 8 cm long and 3 nun wide, and have taper ends. The lumen of the jejunum contains one similar worm.┐┐? The morphological diagnosis included: ┐┐┐Body wide; severe emaciation, intestine; moderate catarrhal enteritis with intralesional nematodes, soft palate; mild locally extensive stomatitis (presumptive).┐┐? The microscopic diagnosis included; peritoneum; marked subacute multifocal neutrophilic histiocytic, lymphoplasmacitic, fibrinous and necrotizing pertitonitis with intralesional bacteria and foreign material. Bone marrow; mild myeloid hyperplasia and left shift.┐┐? Virology verified the presence of feline panleukopenia and fecal floatation verified the presence of ascrid roundworms. 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