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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5250

2. Registrant Information.

Registrant Reference Number: Prosar 1-20298446

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: TENNESSEE

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. 2596-84

Product Name: UltraGuard Flea/Tick Collar for Dogs Red

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

7. b) Type of formulation.

Other (specify)


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 collar was applied to the dog on 10/01/2009.

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

Mixed 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


  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
  • General
    • Symptom - Lethargy
    • Symptom - Weakness
  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Adipsia
    • Symptom - Death

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

1-20298446: A reporter (dog owner) called on 10/04/2009 to report the exposure of his dog to a flea and tick collar containing the active ingredient Tetrachlorvinphos. According to the reporter, the collar was applied to the dog on 10/01/2009. On 10/03/2009, the dog developed vomiting and diarrhea. By the day of the report, the dog was weak, lethargic, and refusing food and water. The collar was removed on 10/04/2009, and there was evidence that the dog had been chewing on the collar. The reporter was advised that routine product use is not expected to result in adverse effects, but individual sensitivity to the ingredient may occur. Ingestion of the product is not recommended and may result in an overexposure to the active ingredient. Signs of active ingredient overexposure were reviewed. A recommendation was made to seek prompt veterinary evaluation due to the dog's small size and potential for dehydration and hypoglycemia. Treatment would include bathing the dog and possibly atropine based on the veterinarian's determination of what is causing the dog's signs. On follow up, the reporter stated that the dog was not evaluated by a veterinarian and died on 10/05/2009. A recommendation was made to consider necropsy to determine the cause of the dog's death. No further information was obtained.

To be determined by Registrant

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


19. Provide supplemental information here