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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5812

2. Registrant Information.

Registrant Reference Number: 070075989

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.

21-JUL-07

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

20-JUL-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. 270255

Product Name: Blue Streak Fly Bait

  • Active Ingredient(s)
    • METHOMYL
      • Guarantee/concentration 1 %
    • (Z)-9-TRICOSENE
      • Guarantee/concentration ,025 %

7. b) Type of formulation.

Granular

Application Information

8. Product was applied?

No

9. Application Rate.

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

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

To be determined by Registrant

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

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Great Dane

4. Number of animals affected

3

5. Sex

Unknown

6. Age (provide a range if necessary )

0.18

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • General
    • Symptom - Death

12. How long did the symptoms last?

Unknown / Inconnu

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

On July 21, 2007 at 11:40 am CDT, the owner's regular DVM called the Animal Product Safety Service (APSS) to discuss the case. According to the regular DVM, the owner placed this product in gallon jugs with holes in it above a run where the puppies were. Three out of five puppies were found dead on July 20, 2007. The owner told the regular DVM that it is possible that during a storm the wind blew some of the product out of the jugs and into the puppy run. The regular DVM performed necropsies on the puppies and found that the intestines were stained the same color as the product, and that the stomach contents looked and smelled like the product.


To be determined by Registrant

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

Death

19. Provide supplemental information here