Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2658

2. Registrant Information.

Registrant Reference Number: 080065589

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.

17-JUN-08

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

07-JUN-08

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. 24784      PMRA Submission No.       EPA Registration No.

Product Name: Farnam Bronco Water Base Equine Fly Spray with Citronella Scent

• Active Ingredient(s)
  • PERMETHRIN
  • PIPERONYL BUTOXIDE
  • PYRETHRINS

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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 7-8, 2008, the owner applied this product to the dog. On June 8, 2008, the owner accidentally got some of the product into the dog's eyes.

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

Alaskan Malamute Mix

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

90

lbs

8. Route(s) of exposure

Skin

Eye

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• Eye
  • Symptom - Irritated eye

• General
  • Symptom - Cancer
  • Specify - Lymphadenopathy

12. How long did the symptoms last?

Unknown / Inconnu

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 June 7, 2008, the owner noticed that the dog's eyes had become irritated. They next day, she took the dog to the veterinarian, where the attending DVM prescribed BNPH ophthalmic ointment. The owner applied the ointment to both eyes for 3-4 days, and when the eyes cleared up, they discontinued use of the product. On June 15, 2008, the owner noticed that the dogs glands had become extremely swollen. On June 17, 2008, the owner contacted the APSS to see if there may be any relation between the ocular exposure to the equine spray and the swollen glands. The owner stated that the dog was scheduled for an ultrasound on June 18, 2008. The APSS staff member stated that if the product was ingested, the risk could include ocular irritation or gastrointestinal upset. She recommended that the owner call back with any additional questions.

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To be determined by Registrant

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

Moderate

19. Provide supplemental information here

The APSS staff member stated this this substance was not related to causing the clinical situation. No additional information is expected, because the lymphadenopathy was not related to the exposure.