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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5430

2. Registrant Information.

Registrant Reference Number: Prosar 1-20692970

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.

Country: CANADA

Prov / State: ONTARIO

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. 25922      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Flea/TIck Drops for Dogs/Puppies Over 30 lbs (Canada)

  • Active Ingredient(s)

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).

The product was applied to the 15 pound dog on 11/09/2009. NOTE: This product is labeled for use on dogs weighing more than 30 pounds.

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

Shih tzu

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 - Vocalizing
  • Nervous and Muscular Systems
    • Symptom - Agitation
    • Symptom - Tail twitching
    • Specify - "Shaking his tail"
    • Symptom - Aggressive behaviour

12. How long did the symptoms last?

Unknown / Inconnu

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

1-20692970: A reporter (dog owner) called on 11/10/2009 to report the exposure of his dog to a flea and tick product containing the active ingredient Permethrin. According to the reporter, the product was applied on 11/09/2009. Within 5 hours following product application, the dog began whimpering, became agitated, and was shaking his tail. The reporter bathed the dog twice with a non-insecticidal shampoo the night of application. At the time of the report, the dog was snapping at the reporter when he attempted to touch him. The reporter was advised that the product is not intended for use on dogs weighing less than 30 pounds. A recommendation was made to use an over-the-counter hydrocortisone product to relieve the signs. The reporter was advised to have the dog evaluated by a veterinarian should the signs persist. On follow up on 11/13/2009, the reporter stated that the dog was evaluated by a veterinarian and diagnosed with a bacterial infection in the tail. He was started on antibiotics and was doing better at the time of the follow up. No further information was obtained. NOTE: The product is not intended for use on dogs weighing less than 30 pounds

To be determined by Registrant

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


19. Provide supplemental information here