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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4386

2. Registrant Information.

Registrant Reference Number: 070056917

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.


5. Location of incident.


Prov / State: OKLAHOMA

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. 374254

Product Name: Adams Flea And Tick Shampoo For Dogs Puppies Cats Kittens

  • Active Ingredient(s)
      • Guarantee/concentration .5 %
      • Guarantee/concentration 1.5 %
      • Guarantee/concentration .15 %

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).

On June 4, 2007 at 11:00 am CDT, the owner bathed his 2 month old, 10 pound, male, intact, Beagle Dog with said product in an attempt to remove the heavy infestation of fleas.

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?

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

10. Time between exposure and onset of symptoms

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

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Vomiting
    • Symptom - Diarrhea
  • General
    • Symptom - Death

12. How long did the symptoms last?

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

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

Not recovered / Non 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 June 5, 2007 at 7:00 am, CDT, twenty hours after the owner bathed the puppy in said product, the owner noted that the animal was anorexic, vomiting, and having bouts of diarrhea. On June 6, 2007 at 8:29 am, CDT, the owner contacted the APSS facility to report the exposure and the signs his animal was displaying. The APSS staff member stated that she would not expect serious problems and also noted that the signs the puppy was displaying were not likely correlated with the exposure. The APSS staff member recommended the owner take the symptomatic puppy into a referring veterinary clinic; owner declined due to financial restrictions.

To be determined by Registrant

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


19. Provide supplemental information here

The owner stated to the APSS staff that he found the puppy as a stray the day the exposure occurred. Per the owner, the dog has never been seen by a vet but intestinal parasites were noted in the feces. The owner contacted the APSS facility on June 7, 2007 at 9:03 am, CDT, to report that the animal had died. The APSS staff member offered to transfer the owner to an APSS DVM but the owner declined.