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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5574

2. Registrant Information.

Registrant Reference Number: 1-34931167

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: OREGON

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)
      • Guarantee/concentration 3.3 %

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

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms


  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Death
  • Eye
    • Symptom - Other
    • Specify - Eyes are cloudy
  • Gastrointestinal System
    • Symptom - Diarrhea
  • General
    • Symptom - Pale mucous membrane colour
  • Gastrointestinal System
    • Symptom - Anorexia

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

1-34931167 - The reporter, a pet owner, indicated that his cats were exposed to an insecticidal powder containing the active ingredient tetrachlorvinphos. The reporter applied the product to his male (Subform III #1) and female 5-month-old, domestic short haired cats four days prior to initial contact with the registrant. The 5 month old female kitten did not develop any symptoms from the exposure. The male kitten licked his hair coat after the product was applied and the following day the cat was vomiting, not eating and lethargic. The reporter bathed the cat on that day. Over the next 2 days the male kitten developed diarrhea and three days after the exposure the reporter noticed that the male kittens eyes were cloudy. The reporter also indicated during the initial call that the male kittens gums were white. The reporter was advised that there were numerous possible causes for the described symptoms and veterinary care was recommended to determine an underlying cause and appropriate treatment. The reporter was further advised that white gums may be an indication that the kitten is anemic from an excessive flea burden. On follow-up call, four days later, the reporter indicated that the male kitten died one day after his call to the registrant. The reporter did not seek veterinary care for his male kitten due to limited finances. 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