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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-1047

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: XX

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: ALBERTA

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.

Product Name: Hartz flea collar for dogs

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

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


Other Units: collar

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).

1 flea collar. was on dog for 6hrs before owner noticed sedation and was then removed.

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

Italian greyhound

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?

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

10. Time between exposure and onset of symptoms

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

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Salivating excessively
  • Renal System
    • Symptom - Inappropriate urination
    • Specify - leaking urine dramatically
  • Nervous and Muscular Systems
    • Symptom - Other
    • Specify - opisthotenus posture
  • Eye
    • Symptom - Pupil dilation
  • Gastrointestinal System
    • Symptom - Vomiting
  • Cardiovascular System
    • Symptom - Bradycardia
  • General
    • Symptom - Abnormal behaviour
    • Specify - acting stoned
  • Respiratory System
    • Symptom - Panting
  • General
    • Symptom - Lethargy
    • Specify - sedate
  • Gastrointestinal System
    • Symptom - Anorexia
    • Specify - not interested in food
  • Nervous and Muscular Systems
    • Symptom - Abnormal gait
    • Specify - walking strange at home
    • Symptom - Difficulty getting up
    • Specify - not wanting to stand
  • General
    • Symptom - Other
    • Specify - Seemed cold at home
  • Nervous and Muscular Systems
    • Symptom - Difficulty walking
  • Respiratory System
    • Symptom - Sneezing
  • Renal System
    • Symptom - Proteinuria
  • Respiratory System
    • Symptom - Runny nose
    • Specify - nasal discharge
  • Nervous and Muscular Systems
    • Symptom - Stiffness
    • Specify - stiffness in legs
  • Respiratory System
    • Symptom - Coughing
  • General
    • Symptom - Vocalizing

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

Fully Recovered / Complètement 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

Owners put collar on and left house for 6 hours. By the time they came home the dog was exhibiting symptoms of sedation and disorientation so they removed the flea collar. His symptoms continued to progress until he was brought into our vet clinic the next morning. Sedated after wearing collar for 6 hours, ate supper then vomited. Overnight became very lethargic and acting 'stoned'. Opisthotenus posture when brought into clinic the next day, increased salivation, bradycardia and leaking urine and dilated pupils. Protenuria on u/a, normal BUN, creatinine, remainder of bloodwork. Protenuria (500mg/dl) remained on recheck u/a 48 hrs later also. Flea collar, only wore for 6 hours before owner removed. Also wore a flea collar approximately 6 months ago (from same box) and had no reaction. We are still monitoring the proteinuria present!!! Clinically the animal is normal but cannot rule out of residue kidney affect.

To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here