Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2145

2. Registrant Information.

Registrant Reference Number: 090066806

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-09

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

15-JUN-09

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. 26921      PMRA Submission No.       EPA Registration No.

Product Name: Bio Spot for Large Dogs Weighing More Than 15 kg

• Active Ingredient(s)
  • PERMETHRIN
  • PYRIPROXYFEN

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PMRA Registration No. 26922      PMRA Submission No.       EPA Registration No.

Product Name: Bio Spot for Small Dogs Weighing Less Than 15 kg

• Active Ingredient(s)
  • PERMETHRIN
  • PYRIPROXYFEN

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

1

Other Units: vial

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 15, 2009, the owner applied the Bio Spot for Large Dogs Weighing More Than 15 kg to the Miniature Schnauzer dog. The use was inappropriate. On June 15, 2009, the owner applied the Bio Spot for Small Dogs Weighing Less Than 15 kg to the Shih Tzu dog to prevent a flea infestation. The use was appropriate.

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

Dog / Chien

3. Breed

Miniature Schnauzer

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

14

kg

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

<=30 min / <=30 min

11. List all symptoms

System

• Skin
  • Symptom - Itchy skin

• Nervous and Muscular Systems
  • Symptom - Anxiety

• Skin
  • Symptom - Dermatitis

• General
  • Symptom - Hyperthermia
  • Symptom - Restlessness

• Eye
  • Symptom - Glazed eye

12. How long did the symptoms last?

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

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Fully Recovered / Complètement 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 15, 2009, the dog became pruritic, anxious, and restless. On June 16, 2009, the owner noticed a moist dermatitis and applied triple antibiotic ointment to the area. On June 17, 2009, the dog had glazed eyes and felt warm. The owner contacted the Animal Product Safety Service (APSS) that same morning. Later that same day, the regular veterinarian called the APSS to discuss the case.

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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

On June 20, 2009, the APSS assistant spoke to the pet owner. On June 17, 2009, the regular veterinarian bathed the dog with liquid dish soap, provided symptomatic care, and asked the owner to monitor at home. The dog made a full recovery on June 18, 2009.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Shih Tzu

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

18

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

• Skin
  • Symptom - Itchy skin

12. How long did the symptoms last?

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

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

Fully Recovered / Complètement 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 15, 2009, the dog became pruritic. On June 17, 2009, the owner contacted the Animal Product Safety Service (APSS). Later that same day, the regular veterinarian called the APSS to discuss the case.

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To be determined by Registrant

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

Minor

19. Provide supplemental information here

On June 20, 2009, the APSS assistant spoke to the pet owner. The owner stated that the dog made a full recovery on June 18, 2009.