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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5306

2. Registrant Information.

Registrant Reference Number: 090129445

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.

20-NOV-09

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

06-NOV-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. 270-349

Product Name: Adams Plus Pyrethrin Dip

  • Active Ingredient(s)
    • DI-N-PROPYL ISOCINCHOMERONATE
      • Guarantee/concentration 1.94 %
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Guarantee/concentration 5.7 %
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration 3.74 %
    • PYRETHRINS
      • Guarantee/concentration .97 %

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 November 6, 2009 the owner applied the product as treatment for fleas.

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

Medical Professional

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 )

6

7. Weight (provide a range if necessary )

10.5

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

<=30 min / <=30 min

11. List all symptoms

System

  • General
    • Symptom - Polydipsia
  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Depression
  • Gastrointestinal System
    • Symptom - Loss of appetite
  • General
    • Symptom - Listless
  • Skin
    • Symptom - Hair loss
  • Cardiovascular System
    • Symptom - Cardiac arrest
  • Nervous and Muscular Systems
    • Symptom - Extensor rigidity
  • General
    • Symptom - Vocalizing
  • Blood
    • Symptom - Blood urea nitrogen increased
    • Specify - Azotemia
    • Symptom - Hypoglycemia
  • Respiratory System
    • Symptom - Apnea
  • 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?

Yes

14. b) How long was the animal hospitalized?

2

Day(s) / Jour(s)

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 November 6, 2009 shortly after the owner applied the dip, the cat had polydipsia, inappetence, and alopecia, and was vomiting, lethargic, depressed, and listless. On November 15, 2009 the owner applied Frontline flea spot on to the cat as he still had fleas. On November 17, 2009 the owner took the cat to the veterinarian, where a chemistry profile and complete blood count were performed, showing the cat had a high blood urea nitrogen and high serum creatinine. On that same day, fluid therapy, doxycycline, and nutritional support were given. The cat was hospitalized until November 19. On November 20, 2009 the owners took the cat back to the veterinarian where epinephrine and doxapram were given as the cat had a low temperature and low serum glucose. The cat went into cardiac arrest, had extensor rigidity, vocalized, had azotemia and hypoglycemia, and apnea. The regular veterinarian then called the Animal Product Safety Service (APSS). The APSS veterinarian recommended supportive and symptomatic care, along with a diagnostic evaluation, and call back with questions. Later that day, an APSS assistant called the veterinary clinic to follow up the case. The veterinary staff stated the cat died shortly after the APSS consultation. A necropsy was recommended by APSS staff.


To be determined by Registrant

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

Death

19. Provide supplemental information here

On November 23, 2009 an APSS assistant called the veterinary clinic to follow up on the case and recommended necropsy. Later that afternoon, the veterinarian clinic contacted the APSS to update the case. She stated the owners had declined the necropsy.