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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4985

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16285525

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: MISSOURI

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 and Tick Collar for Puppies White

  • Active Ingredient(s)
      • Guarantee/concentration 1.02 %
      • Guarantee/concentration 14.55 %

7. b) Type of formulation.

Other (specify)

Collar treated with active ingredient

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).

The reporter's dog was playing on 6/14/08 for 15 minutes with a puppy to whom the product had been applied.

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

Dog / Chien

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?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Salivating excessively
    • Symptom - Vomiting
  • General
    • Symptom - Edema
  • Skin
    • Symptom - Other
    • Specify - "Bad body odor"
  • General
    • Symptom - Other
    • Specify - "Looked like cornmeal on hair" and covered in flies
    • Symptom - Death
    • Symptom - Hiding

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?

Other / Autre

specify No witnessed exposure to the product. The reporter's pet was playing with a puppy to whom a flea and tick collar had been applied.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-16285525: The reporter called on 6/16/08 to report the sudden passing of her 7 month old dog after possible exposure to a flea and tick product containing the active ingredients Methoprene and Tetrachlorvinphos. According to the reporter, her dog had been playing with her son¿¿¿s puppy on 6/14/08 for 15 minutes. The son¿¿¿s puppy had been wearing a flea and tick collar and the reporter wondered if her dog may have ingested any product. About 15 minutes after playing with the puppy, her dog had vomited one time and had also begun to salivate. The dog had then run away and hid in the woods for several hours. The reporter stated that upon his return, her dog had a ¿¿¿bad body odor¿¿¿, seemed edematous, was covered in flies and had what looked to be cornmeal in his hair. The dog was bathed twice and per the reporter seemed to be better. He passed away suddenly the evening of 6/15/08 without veterinary care. The reporter was unclear as to whether or not his symptoms persisted or worsened prior to his sudden death. The safety profile of the product was discussed during the 6/16 call, including the fact that sudden death would not be an expected reaction to exposure to the product.

To be determined by Registrant

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


19. Provide supplemental information here