Health Canada
www.hc-sc.gc.ca
Common menu bar links
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-3859
2. Registrant Information.
Registrant Reference Number: 90101750
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.
09-SEP-095. Location of incident.
Country: UNITED STATES
Prov / State: NEW YORK
6. Date incident was first observed.
08-SEP-09Product 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. 270-333
Product Name: Scratchex Flea and Tick Shampoo for Dogs and Cats
- Active Ingredient(s)
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- Guarantee/concentration .24 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration .144 %
- PYRETHRINS
- Guarantee/concentration .072 %
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
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).
Dog was heavily infested with fleas. Owner first applied on August 19, 2009. Treatment did not work and owner bathed dog again on September 7, 2009 to treat the flea infestation.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
Dog / Chien
3. Breed
Pomeranian
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
19
7. Weight (provide a range if necessary )
2.0
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>1 wk <=1 mo / > 1 sem < = 1 mois
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- General
- Symptom - Lethargy
- Symptom - Weakness
- Gastrointestinal System
- Symptom - Loss of appetite
- Nervous and Muscular Systems
- Symptom - Depression
- General
- 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 September 8, 2009 the dog was lethargic, mildly weak, and mildly inappetant. Later that same day, the dog became moderately weak and moderately inappetant. On September 9, 2009 the pet owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated that serious problems would not be expected with the labeled use of the product. She recommended that the pet owner take the dog 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
The APSS veterinarian stated that the substance was considered to have a doubtful likelihood of causing the clinical situation. On September 22, 2009 an APSS technician spoke to the pet owner. The pet owner stated that she took the dog to the veterinarian on September 9, 2009. The veterinarian treated dog with SQ fluids and the owner elected to take the dog home. The dog died on the way home from the veterinarian's office on September 9, 2009.
