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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4387

2. Registrant Information.

Registrant Reference Number: 070055198

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

Address: 301 W. Osborn Road

City: Phoenix

Prov / State: AZ

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.

02-JUN-07

5. Location of incident.

Country: UNITED STATES

Prov / State: TENNESSEE

6. Date incident was first observed.

30-MAY-07

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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 270-278

Product Name: Bio Spot Flea and Tick Control for Dogs Between 15 and 33 Lbs.

  • Active Ingredient(s)
    • PERMETHRIN
      • Guarantee/concentration 45 %
    • PYRIPROXYFEN
      • Guarantee/concentration 5 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 270-278

Product Name: Bio Spot Flea and Tick Control for Dogs Over 66 lbs

  • Active Ingredient(s)
    • PERMETHRIN
      • Guarantee/concentration 45 %
    • PYRIPROXYFEN
      • Guarantee/concentration 5 %

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

1

Other Units: vial

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 May 30, 2007, at 12:00 pm, CDT the owner applied one vial of the Bio Spot for Dogs over 66 pounds to her 3 year old, 75 pound, male, intact, Old English Bulldog and then applied one vial of Bio Spot for Dogs Between 15 and 33 pounds to her 6 month old, 25 pound, female intact, Old English Bulldog. The product was applied dermally to the animal. The owner was applying the product as a preventive measure.

To be determined by Registrant

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

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Old English Bulldog

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

75

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Fasciculations
  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
    • Symptom - Recumbent
  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Death
  • Gastrointestinal System
    • Symptom - Diarrhea
  • Nervous and Muscular Systems
    • Symptom - Coma
  • Eye
    • Symptom - Nystagmus
  • General
    • Symptom - Hypothermia
  • Gastrointestinal System
    • Symptom - Salivating excessively
  • General
    • Symptom - Adipsia

12. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

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

Yes

14. a) Was the animal hospitalized?

Unknown

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 May 31, 2007, at 7:00 am CDT, the owner noticed that the dog was having fasciculations,lethargic, adipsic, and drooling.. At that time the owner bathed the dog multiple times with a mild dish washing liquid. On June 02, 2007, at 8:00 am, CDT, the owner noticed that the dog was experiencing muscle tremors, anorexic and was laterally recumbent. On June 3, 2007 at 8:30 am, CDT, the owner took the dog to her regular veterinarian, where the dog was experiencing diarrhea, nystagmus, was comatose, and hypothermic. The owner's veterinarian treated the dog with atropine, Pralidoxime Chloride, and placed the dog on IV fluids. On June 03,2007 at 7:00 pm, CDT, the dog had passed away.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Old English Bulldog

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.5

7. Weight (provide a range if necessary )

25

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
  • Gastrointestinal System
    • Symptom - Drooling
  • General
    • Symptom - Death

12. How long did the symptoms last?

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

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

No

14. a) Was the animal hospitalized?

No

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 May 30 2007, at 6:00 pm, CDT, the owner noticed that the puppy was experiencing muscle tremors and was hypersalivating. According to the owner she contacted her regular DVM and was told that there was not much that could be done. The owner said that the puppy slept out in the kennel overnight was dead in the morning. By the time the owner had called to report the exposure they had already buried the puppy.


To be determined by Registrant

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

Death

19. Provide supplemental information here