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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-1866

2. Registrant Information.

Registrant Reference Number: 070061928

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.

18-JUN-07

5. Location of incident.

Country: UNITED STATES

Prov / State: MICHIGAN

6. Date incident was first observed.

17-JUN-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. 270278

Product Name: Bio Spot Flea and Tick Control For Dogs Between 15 and 33 lbs270278

  • 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.

1.5

Units: mL

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 16, 2007 at 7:00 pm, CDT, the owner applied this product to her 3 year old, 7 pound, female, spayed, Domestic Shorthair. The product was applied dermally to the animal.

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

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

7

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

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

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 - Seizure
  • General
    • 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?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

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 17, 2007 at 3:00 am, CDT, the owner noticed that the cat had begun to seizure. The owner took her cat to the veterinarian at 4:00 am that same morning, prior to contacting the Animal Product Safety Service(APSS). The veterinarian treated the cat with Valium and phenobarbital and those drugs did not control the signs. The cat died on June 18, 2007 at 10:00 am, CDT. The APSS veterinarian received a call from the attending veterinarian after the pet had already passed away. The attending veterinarian explained to the APSS veterinarian that the owner had brought the product with her to the clinic. The external package was the cat product, but the agent inside was labeled for dogs.


To be determined by Registrant

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

Death

19. Provide supplemental information here