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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2013-6332

2. Registrant Information.

Registrant Reference Number: 1-35164057

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)

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?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Melena
  • Nervous and Muscular Systems
    • Symptom - Seizure
    • Symptom - Difficulty walking
    • Specify - Not Walking
  • General
    • Symptom - Death
  • Gastrointestinal System
    • Symptom - Other
    • Specify - hemorrhage
  • Respiratory System
    • Symptom - Pulmonary edema
    • Symptom - Respiratory congestion

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?


Hour(s) / Heure(s)

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

1-35164057 - The reporter, a pet owner, indicated that his dog was exposed to a spot-on insecticide containing the active ingredients permethrin and methoprene. The reporter applied the product to his 4-year-old, 25 pound, female dog either four or five days prior to initial contact with the registrant and the following day the dog was not walking. Later the dog had tarry diarrhea and two days prior to initial contact the dog started having seizures. The following morning the dog was brought to a veterinarian where blood work was run and the dog was treated with vitamin B12. The dog died at the veterinary clinic that night. The reporter stated that the veterinarian had indicated that the product had put a toxin in his dogs blood stream that shut down the liver. The reporter was advised that the product would not be expected to adversely affect the liver a necropsy was recommended to help determine the cause for the dogs death. The owner declined a necropsy. 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

Status update: 1-35164057 - The pet owner did end up agreeing to a necropsy. Gross necropsy results are as follows: Gastrointestinal hemorrhage with severe acute pulmonary edema and congestion. Histologic diagnosis: Acute multiorgan hemorrhage, marked extramedullary hematopoiesis, bone marrow hyperplasia - erythroid and megakaryocytic. The pathologist hypothesized that the gastrointestinal hemorrhage may have been secondary to thrombocytopenia as no evidence if enteritis was evident to account for the GI bleeding. The pathologist indicated that the application of the registrant flea and tick product and the dog's death were likely coincidental.