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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-6835

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-35440198

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 pounds

  • 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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Jack Russell Terrier

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

Unknown / Inconnu

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
  • Skin
    • Symptom - Inflammation of the skin
  • Renal System
    • Symptom - Blood in urine
  • Blood
    • Symptom - Leukocytosis

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


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

1-35440198 - The reporter, a veterinary technician, indicated that a client's dog was exposed to a registrant spot-on insecticide containing the active ingredients permethrin and methoprene. The reporter indicated that the product had been applied two days prior to initial contact with the registrant. The following day, the dog vomited 4 times and developed diarrhea. At the time of the initial call the dog was at the veterinary clinic for care. The reporter was advised that with ingestion of the product transient gastrointestinal irritation is possible but vomiting and diarrhea can be seen secondary to numerous possible causes. Diagnostics were recommended to rule out other possible causes. On follow-up call, one day later, the treating veterinarian stated that the dog had returned that day for additional care. Per the treating veterinarian the dog developed signs of vomiting, diarrhea, and dermal inflammation about 2 hours after application of the product. The dog presented again with hematuria and leukocytosis. The dog was treated with IV fluids, nausea medication, and an antibiotic injection. The dog was clinically improved and was released to the owner. Hematuria and leukocytosis would not be expected after exposure to the product. 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