Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-2635
2. Registrant Information.
Registrant Reference Number: 090077136
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.
10-JUL-09
5. Location of incident.
Country: UNITED STATES
Prov / State: WEST VIRGINIA
6. Date incident was first observed.
10-JUL-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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 270-348
Product Name: Adams Water Based Flea and Tick Mist
- Active Ingredient(s)
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- Guarantee/concentration 2 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration .75 %
- 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).
On July 10, 2009, the owner applied the product to the cat to treat a flea infestation.
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
Cat / Chat
3. Breed
Domestic Shorthair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
9
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>8 hrs <= 24 hrs / >8 h <= 24 h
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 - Fasciculations
- Symptom - Muscle tremors
- Nervous and Muscular Systems
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 July 10, 2009, the cat had moderate fasciculations, mild tremors, and was mildly anorexic. Later that same day, the owner bathed the cat with mild soap. The cat continued to have fasciculations, and later that day, the tremors and anorexia progressed from mild to moderate and the cat had a seizure. The pet owner then contacted the Animal Product Safety Service (APSS). The APSS veterinarian recommended that the owner take the cat to the veterinarian and have the veterinarian call for information.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
On July 17, 2009, an APSS assistant spoke with the pet owner's extended family. The extended family member stated that the cat was taken to the veterinarian on July 10, 2009. The cat was hyperthermic, and was treated with atropine, phenobarbital, and diazepam. The cat died later that same evening. A necropsy was not possible because the body was no longer available.