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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-1604

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-36649971

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: CALIFORNIA

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. 2596-139

Product Name: UltraGuard Plus Flea/Tick Collar for Cats/Kittens Safety Release Snap

  • Active Ingredient(s)
      • Guarantee/concentration 1.02 %
      • Guarantee/concentration 14.9 %

7. b) Type of formulation.

Other (specify)

Impregnated 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


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

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms


  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Agitation
  • General
    • Symptom - Hiding
    • Symptom - Vocalizing
  • Renal System
    • Symptom - Inappropriate urination
  • General
    • Symptom - Lethargy
    • Symptom - Weakness
  • Nervous and Muscular Systems
    • Symptom - Ataxia
  • Respiratory System
    • Symptom - Panting
    • Symptom - Difficulty Breathing
  • General
    • Symptom - Other
    • Specify - "allergic reaction"

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

1-36649971 - The reporter, a pet owner, indicated that his cat was exposed to an insecticidal collar containing the active ingredients tetrachlorvinphos and methoprene. The reporter placed the collar on his 9-year-old, 7 pound, female Siamese cat eleven days prior to initial contact with the registrant. Three hours after the collar was applied the cat was breathing heavy, panting, running around and hiding. The following morning the reporter removed the collar and that afternoon he bathed his cat. Two days after the collar had been applied the reporter brought his cat to the veterinarian. The veterinarian indicated that the cat was having an allergic reaction and she was given an unknown injectable medication to calm her down. Blood work was drawn but the reporter did not know the results of the blood work. When the reporter came home from the veterinary clinic he noticed that his cat was lethargic, urinating on herself and crying. Four days after the collar had been applied the cat was still weak. Eight days after the collar had been applied the cat seemed to be getting better but that night she worsened and the following day she was staggering around, not doing well and she died that day. The reporter was advised that the described symptoms are not expected and a necropsy could help determine the cause of death but the cat had already been buried. 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