Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-3859
2. Registrant Information.
Registrant Reference Number: 080100867
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.
09-SEP-08
5. Location of incident.
Country: UNITED STATES
Prov / State: OHIO
6. Date incident was first observed.
08-SEP-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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 69332-3-270
Product Name: Bio Spot For Cats One Step Vial
- Active Ingredient(s)
- ETOFENPROX
- Guarantee/concentration 55 %
- PYRIPROXYFEN
- Guarantee/concentration 2.2 %
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 270-278
Product Name: Bio Spot Flea and Tick Control For Dogs 33lbs to 66lbs
- Active Ingredient(s)
- D-LIMONENE
- PERMETHRIN
- Guarantee/concentration 45 %
- PYRIPROXYFEN
- Guarantee/concentration 5 %
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
Unknown
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
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Domestic Shorthair
4. Number of animals affected
2
5. Sex
Male
Female
6. Age (provide a range if necessary )
0.42
7. Weight (provide a range if necessary )
3.5
lbs
8. Route(s) of exposure
Skin
Unknown
9. What was the length of exposure?
>8 hrs <= 24 hrs / >8 h <= 24 h
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Nervous and Muscular Systems
12. How long did the symptoms last?
Persisted until death
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
Died
16. How was the animal exposed?
Other / Autre
specify Treatment: Product made for cats, Relay exposure: Product made for dogs
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
On September 8, 2008 the owner stated that the kittens had muscle tremors. On September 9, the kittens died.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
On September 12, an APSS technician called the owner to follow up the case. The owner declined necropsies due to the cost.