Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-4647

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-31640066

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. 29283      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Pro Flea/Tick Drops for Dogs/Puppies under 30 lbs

  • Active Ingredient(s)

PMRA Registration No. 25654      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Flea/Tick Spray for Dogs (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).

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?

>1 wk <=1 mo / > 1 sem < = 1 mois

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms


  • Nervous and Muscular Systems
    • Symptom - Muscle weakness
    • Symptom - Ataxia
  • Gastrointestinal System
    • Symptom - Melena
    • Symptom - Diarrhea
  • Nervous and Muscular Systems
    • Symptom - Difficulty walking
    • Specify - weak in the rear legs
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Specify - black tarry diarrhea

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

Not recovered / Non rétabli

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

1-31640066- The reporter, a veterinarian, indicated that a dog was exposed to an insecticidal spray containing the active ingredient Tetrachlorvinphos, another insecticidal spot-on product containing the active ingredients permethrin and methoprene and a third non-registrant insecticidal shampoo with unknown active ingredients. The pet owner applied the spot-on product to her 7-year-old, male, 14 pound, mixed breed dog three weeks prior to initial contact with the registrant. After applying the spot-on product the pet owner bathed the dog with a non-registrant flea and tick shampoo and then applied a registrant insecticidal spray to the dog. Shortly after the products were applied the dog developed symptoms which have persisted until the time of initial contact. The pet owner did not seek veterinary assistant until the time of initial contact due to a lack of resources. At the time of initial contact, the reporter indicated that the dog was weak in the rear legs, lethargic and had black tarry diarrhea. The reporter was advised that neurologic symptoms with exposure to the AI would be generalized not localized as is reported in this dog. The reporter was further advised that melena is inconsistent with exposure to the registrant products. Decontamination and further diagnostics were recommended to identify a cause for the dogs symptoms. On follow-up call, one day later, a veterinarian at the clinic indicated that the dog was still suffering from hind limb ataxia and they suspected it had a spinal issue; not a toxicity. 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