Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2963

2. Registrant Information.

Registrant Reference Number: 090087609

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.

04-AUG-09

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW JERSEY

6. Date incident was first observed.

01-AUG-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. 270-294

Product Name: Bronco Water Base Equine Fly Spray Plus Citronella Scent

• Active Ingredient(s)
  • PERMETHRIN
    • Guarantee/concentration .1 %
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration .5 %
  • PYRETHRINS
    • Guarantee/concentration .05 %

---

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 or around July 14, 2009, the owner applied the product to the lamb's mother once or twice every day.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Sheep / Mouton

3. Breed

Ovine Uspecified

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.06

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

10. Time between exposure and onset of symptoms

>1 wk <=1 mo / > 1 sem < = 1 mois

11. List all symptoms

System

• General
  • Symptom - Polydipsia
  • Symptom - Lethargy
  • Symptom - Weakness

• Nervous and Muscular Systems
  • Symptom - Difficulty getting up

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Death

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 Contact with treated animal

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

On August 1, 2009, the lamb was polydipsic. On August 3, 2009, the lamb was lethargic, weak, having difficulty getting up, and was anorexic. On August 4, 2009, the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian recommended that the owner take the lamb to the veterinarian and call back with questions.

---

To be determined by Registrant

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

Death

19. Provide supplemental information here

On August 11, 2009 an APSS technician spoke to the owner. The owner stated that the lamb died on August 4, 2009. The lamb was not seen by a veterinarian. The owner declined a necropsy because the body was no longer available.