Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-2827
2. Registrant Information.
Registrant Reference Number: 080066309
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.
19-JUN-08
5. Location of incident.
Country: UNITED STATES
Prov / State: VERMONT
6. Date incident was first observed.
Unknown
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. 10375
Product Name: Wipe Liquid Wipe On Fly Protectant (Canadian Product)
- Active Ingredient(s)
- BUTOXYPOLYPROPYLENE GLYCOL
- Guarantee/concentration 20 %
- DI-N-PROPYL ISOCINCHOMERONATE
- Guarantee/concentration 1 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration .5 %
- PYRETHRINS
- Guarantee/concentration .2 %
7. b) Type of formulation.
Liquid
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).
The owner applied the product twice a week from May 1, 2004 to June 5, 2008. Other pyrethroid products and a homemade vinegar solution were also used.
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
Horse / Cheval
3. Breed
Canadian Warmblood Mix
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
15
7. Weight (provide a range if necessary )
1350
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Nervous and Muscular Systems
- Liver
- Symptom - Hepatic failure
- Symptom - Elevated liver enzymes
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
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
In 2006 and again on May 4, 2008, the horse collapsed. The attending veterinarian drew and tested the horse's blood and found that the horse had acute hepatic failure and elevated liver enzymes. On June 19, 2008, the owner contacted the APSS. The APSS veterinary technician stated that the signs were not consistent with the product. The APSS veterinary technician recommended that a diagnostic evaluation be performed on the horse to rule out other causes.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Major
19. Provide supplemental information here
On July 1, 2008, the owner contacted the APSS with additional questions about pyrethroids. The APSS veterinarian stated that the liver signs seen in her horse would not be caused by this product.