Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-7019

2. Registrant Information.

Registrant Reference Number: 160160878

Registrant Name (Full Legal Name no abbreviations): Farnam Companies, Inc.

Address: 301 W. Osborn Road

City: Phoenix

Prov / State: Arizona

Country: USA

Postal Code: 85013

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

28-OCT-16

5. Location of incident.

Country: UNITED STATES

Prov / State: LOUISIANA

6. Date incident was first observed.

Unknown

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.

Active(s)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 270-373

Product Name: Just One Bite II Bar 16 Oz For Use In And Around Agricultural Building

• Active Ingredient(s)
  • BROMADIOLONE
    • Guarantee/concentration .005 %

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7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Yes

9. Application Rate.

16

Units: oz (wts) / oz (pds)

10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'ext.maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Between October 26, 2016 the owner's wife broke up the bar into four 4 ounce pieces and placed them outside in the yard. That day the owner noticed the bar was missing, but didn't think much of it.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Labrador Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

10.0

7. Weight (provide a range if necessary )

70.0

lbs

8. Route(s) of exposure

Oral

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

System

• Gastrointestinal System
  • Symptom - Loss of appetite

• General
  • Symptom - Lethargy
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

On October 27, 2016 the the dog developed inappetence. On October 28, 2016 the dog developed lethargy. The owner then called the veterinarian. The owner then contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated the risk if for coagulopathy. The APSS veterinarian also stated this is a dose of concern and is a dose that could start effecting her clotting ability. The APSS assistant also relayed the APSS veterinarian's instructions to have the owner call the clinic and see if they would be able to test the dog's clotting ability in house and if they can then we would recommend taking the dog to the veterinarian and getting her started on vitamin K1. If the owner's regular clinic cannot check in house, we would recommend he find a clinic that can. The APSS assistant provided the case and call back number and recommended having the veterinarian call for information.

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To be determined by Registrant

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

Death

19. Provide supplemental information here

The APSS veterinarian stated that the substance was considered to have a medium likelihood of causing the clinical situation. On October 28, 2016 the owner called the APSS to provide an update. The owner stated the veterinarian came to the house and examined the dog (bright, alert, responsive (BAR), running around, and there was some blood on her tail). The owner stated the veterinarian determined that the dog did get some poison, but not very much. The veterinarian gave her an injection of vitamin K and left another dose for the next day, but said she should be okay after that. The APSS veterinarian discussed that this is not the appropriate treatment for this situation. The APSS veterinarian stated that the vitamin K is needed for at least 3 weeks and if she is bleeding from an anticoagulant, she needs to be hospitalized and receive transfusions. The APSS veterinarian also stated that if that is not possible, would advise exercise restriction and by mouth (PO) vitamin K (at least 100 milligrams (mg) daily) for 3 weeks and a follow up clotting test. The APSS veterinarian again recommended having the veterinarian call the APSS. On October 30, 2016 an APSS assistant called the owner to follow up. The owner reported that the dog's signs continued and he was planning on picking up oral vitamin K from his vet that day, but the dog had died at home last night (October 29, 2016). The owner stated they had buried the dog's body at home. The APSS assistant consulted with an APSS veterinarian regarding the patient's death. A necropsy was not possible.