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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3870

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23167609

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.



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 Large Dogs White

  • 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).

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

Medical Professional

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

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms


  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Death
    • Symptom - Fever
    • Symptom - Dehydration
  • Blood
    • Symptom - Coagulopathy

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

1-23167609- The caller, a veterinarian, reports a patient of hers has been exposed to a pesticide containing the active ingredient Tetrachlorvinphos. The caller reports the animal, an eight year female 55 pound Golden retriever dog, had the product (a collar) applied one day prior to the initial contact with the registrant. The animal was reported by the owner to have developed the signs of lethargy, vomiting, fever, and dehydration within five hours of application of the collar. The caller was most interested in what testing and treatment was supported by the registrant in the event of suspected exposure. The caller was informed of registrant supported cholinesterase testing. The veterinarian had indicated her treatment plan for the animal included bathing, intravenous fluid therapy, antibiotics, antiemetics, and blood work. On routine callback the next day the veterinarian reported the animal was doing better. The vomiting was under control. On routine call back three days later the veterinarian had advised the animal had died. She reported the cholinesterase test came back "normal". The veterinarian had performed an in clinic gross necropsy and had observed "liver changes" (unspecified) that she perceived as the overall cause of death. The veterinarian was advised of a registrant supported necropsy program. No further information is available.

To be determined by Registrant

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


19. Provide supplemental information here