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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2753

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-33230397

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. 2596-84

Product Name: Ultraguard Flea/Tick Collar for Large Dogs White

  • Active Ingredient(s)
      • Guarantee/concentration 14.55 %

7. b) Type of formulation.

Other (specify)

Impregnated Animal Collar

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


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?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms


  • Nervous and Muscular Systems
    • Symptom - Seizure
    • Symptom - Disorientation
  • General
    • Symptom - Swelling
    • Specify - brain swelling secondary to seizures
    • Symptom - Abnormal behaviour
    • Specify - circling
    • Symptom - Death
  • Cardiovascular System
    • Symptom - Stroke

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

1-33230397 - The reporter, a pet owner, indicated that his daughters dog was exposed to an insecticidal collar containing the active ingredient tetrachlorvinphos. The reporter indicated that the collar was applied to his daughters 8 year old, 100 pound, male mixed breed dog either 13 or 14 days prior to initial contact with the registrant and then two or three days after collar application the dog had a seizure. The following morning the dog had another seizure and was taken to the veterinarian where the collar was removed (3-4 days after the collar had been initially placed on the dog). It is uncertain what other medical treatment or diagnostics were provided during that visit. The dog was taken home that evening and the following morning the dog had another seizure and was taken back to the veterinarian who placed the dog on some unknown pill and later that day the daughter took the dog home and bathed her dog. The next day the dog was taken back to the veterinarian who then diagnosed the dog with having a stroke and swelling of the brain secondary to the seizures. How the diagnosis was made is not indicated. The reporter did indicate that blood work was run by the veterinarian at some point which per the reporter was non-diagnostic. The reporter indicated that the dog was placed on an unknown medication for the stroke and brain swelling. The reporter states that the dog has only had the three seizures but at the time of initial contact the dog was not doing well. It was still eating and drinking but it is disorientated, moving in circles and bumping into furniture. The reporter does indicate that the registrants flea and tick collars have been used on this dog in the past without incident. The reporter was advised that the product is well tolerated by most dogs but some dogs can have an unrecognized sensitivity to the product. Cholinesterase testing was recommended to help determine if the dogs symptoms were from exposure to this product. On follow-up call, three days later, the reporter indicated that the dog passed away in the kennel at the veterinarians one day after initial contact. The dog's body was submitted for necropsy. No further information is available at this time.

To be determined by Registrant

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


19. Provide supplemental information here