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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-2312

2. Registrant Information.

Registrant Reference Number: 2020-CA-000043

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. 30731      PMRA Submission No.       EPA Registration No.

Product Name: Hartz UltraGuard Pro Drops for Dogs Over 28 kg

  • 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).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

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


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?

>1 mo <= 6 mos / > 1 mois < = 6 mois

10. Time between exposure and onset of symptoms

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

11. List all symptoms


  • Skin
    • Symptom - Hair loss
    • Symptom - Dry skin
    • Specify - desquamation

12. How long did the symptoms last?

>1 mo and <= 2mos / >1 mois et < = 2mois

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

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

On 13-Jan-2020, a 8 year old, 85 pound, neutered, female, Rottweiler dog, in unknown condition, with concomitant medical condition of pyometra, was administered 1 tube of Hartz UltraGuard Pro Drops for Dogs Over 28 kg (Phenothrin (Sumithrin) / S Methoprene) via the topical route by the animal owner. On approximately 15-Jan-2020, the dog developed generalized alopecia. On approximately 10-Feb-2020, the dog was administered 1 tube of Hartz UltraGuard Pro Drops for Dogs Over 28 kg (Phenothrin (Sumithrin) /S Methoprene) via the topical route by the animal owner. The liquid did not absorb post application, as the previous dose had. On approximately 17-Feb-2020, the dog¿¿¿¿¿¿s clinical sign of generalized alopecia worsened and the dog exhibited desquamation. The dog was evaluated by a veterinarian and a skin scraping was performed and there were no abnormalities detected. No additional treatments were provided. On approximately 10-Mar-2020, the clinical signs resolved and the dog recovered. Discontinuing use of product and further consultation with a veterinarian to rule out other possible etiologies was recommended. No further information was received in this case.

To be determined by Registrant

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


19. Provide supplemental information here

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.