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
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.