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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-1242

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-36609730

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: CALIFORNIA

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. 2596-162

Product Name: UltraGuard Plus Flea/Tick Dog Shampoo Soothing Aloe

  • Active Ingredient(s)
      • Guarantee/concentration .27 %
      • Guarantee/concentration .025 %

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

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

11. List all symptoms


  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Difficulty walking

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

1-36609730 - The reporter, a pet owner, indicated that his two dogs were exposed to an insecticidal dog shampoo containing the active ingredients phenothrin and pyriproxyfen. The reporter indicated that a few hours prior to initial contact with the company he had bathed his 5-week-old, 0.5 pound, male mixed breed dog (Subform III #1) and his 5-week-old, 1 pound, male mixed breed dog with the shampoo. The reporter then left home for a couple of hours and when he returned he found his 0.5 pound puppy dead and his 1 pound puppy was having trouble walking. The reporter did see that per labeled directions the product is not meant for dogs less than 6 months of age. A necropsy was recommended to help determine the cause of death. Bathing with a non-insecticidal shampoo, followed by immediate veterinary care was recommended for the 1 pound puppy. On follow-up call, one day later, the reporter indicated that he had bathed the 1 pound puppy with a non-insecticidal shampoo and symptoms resolved within 4 hours. No veterinary care was needed. The reporter had not yet submitted the 0.5 pound puppy for 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