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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2688

2. Registrant Information.

Registrant Reference Number: PROSAR 1-22453351

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: MINNESOTA

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. 2596-150

Product Name: UltraGuard Plus Flea and Tick Drops Plus for Dogs/Puppies over 60 lbs

  • Active Ingredient(s)
      • Guarantee/concentration 2.3 %
      • Guarantee/concentration 85.7 %

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 reporter applied the product on 4/27 or 4/28/10 and first noticed symptoms on 4/29/10. The reporter indicated the dog was taking medication for the treatment for Lyme disease.

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

Golden Retriever

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


  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
  • Nervous and Muscular Systems
    • Symptom - Difficulty walking
  • General
    • 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

1-22453351: The reporter called the registrant on 4/30/10 to report the death of her 5 year old female Golden Retriever after the dog had been exposed to flea and tick drops containing the active ingredients Methoprene and Phenothrin. According to the reporter (animal owner), the product was applied on 4/27 or 4/28/10. The reporter first noticed symptoms on 4/29/10 when the dog seemed lethargic. By 4/30, the dog had stopped eating and drinking and was having difficulty walking. The reporter then contacted her veterinarian, who told her the dog was having a neurological reaction to the product. The veterinarian instructed her to bathe the dog in Dawn Dish Soap and contact the registrant. At the time of the call, the reporter indicated she had bathed the dog and was wondering what else she needed to do. The reporter indicated the dog was taking medication for the treatment of Lyme disease. During the call the safety profile of the product was discussed, and a recommendation was made to take the dog to the veterinarian for supportive and symptomatic care. A follow-up call on 5/3/10 revealed that the dog had died later in the day on 4/30/10 and had been buried. The reporter had not been able to take the dog to a veterinarian.

To be determined by Registrant

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


19. Provide supplemental information here

The reporter applied the product on 4/27 or 4/28/10 and first noticed symptoms on 4/29/10. The reporter indicated the dog was taking medication for the treatment for Lyme disease.