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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-1430

2. Registrant Information.

Registrant Reference Number: PROSAR 1-21690001

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


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. 26489      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Plus Flea/TIck Drops for Dogs/Puppies Under 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 dog on 02/14/2010.

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

Terrier Mix

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


  • Skin
    • Symptom - Erythema
    • Symptom - Irritated skin
  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Anxiety
    • Symptom - Muscle spasm

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

1-21690001: A reporter (dog owner) called on 02/17/2010 to report the exposure of her dog to a flea and tick product containing the active ingredients Methoprene and Permethrin. According to the reporter, the product was applied to the dog on 02/14/2010. The following day, the application site was red and irritated. The reporter contacted a veterinarian who instructed her to bathe the dog. At the time of the report, the dog was lethargic and anxious. The reporter was advised that the product is generally well-tolerated, but that individual animals may have a sensitivity resulting in red, irritated skin, lethargy, and depression. A recommendation was made to re-bathe the animal to fully decontaminate the application site. The reporter was also advised that an over-the-counter topical hydrocortisone spray for pets may be used to relieve the signs. The reporter called again on 02/17/2010 to report that she had taken the dog to a veterinarian where he was prescribed a topical product and a medication. On follow up on 02/19/2010, the reporter stated that the dog developed muscle spasms an unspecified time following product application and was brought to the veterinarian a second time. The dog was treated with a topical cream and Robaxin. The reporter was again advised that adverse effects as described are not typical with routine product use. The company's reimbursement policy was discussed. 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