Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-2780
2. Registrant Information.
Registrant Reference Number: 090083134
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.
24-JUL-09
5. Location of incident.
Country: UNITED STATES
Prov / State: VIRGINIA
6. Date incident was first observed.
24-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. 270-341
Product Name: Adams Flea and Tick Shampoo
- Active Ingredient(s)
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- Guarantee/concentration .51 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration 1.5 %
- PYRETHRINS
- Guarantee/concentration .15 %
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 24, 2009, the pet owner bathed the cat with the product 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
Female
6. Age (provide a range if necessary )
0.33
7. Weight (provide a range if necessary )
2
lbs
8. Route(s) of exposure
Skin
Oral
9. What was the length of exposure?
>8 hrs <= 24 hrs / >8 h <= 24 h
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Nervous and Muscular Systems
- Skin
- Symptom - Pale mucous membrane colour
- Specify - White Mucous Membranes
- General
- Symptom - Hemorrhage
- Symptom - Death
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?
No
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 24, 2009, the kitten was laterally recumbent and had white mucous membranes, and was bleeding from her back. The pet owner contacted the Animal Product Safety Service (APSS) that same day. The APSS veterinarian stated that she suspected these signs were from flea bite anemia and recommended that the pet owner take the kitten to the veterinarian immediately and have the veterinarian call for information. The pet owner contacted the APSS again on July 25, 2009 and stated that she took the kitten to the veterinarian on July 24, 2009. The veterinarian gave the kitten a vitamin injection and discharged the kitten to the owner. No other treatment was given. The kitten died at home on July 25, 2009. The APSS veterinarian recommended a necropsy.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
On August 6, 2009 APSS contacted owner to update case. The owner stated that her other cat, which had not been treated with the product, died as well. The owner said that it was from flea anemia.