Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3514

2. Registrant Information.

Registrant Reference Number: 100092114

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.

16-JUL-10

5. Location of incident.

Country: UNITED STATES

Prov / State: LOUISIANA

6. Date incident was first observed.

16-JUL-10

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 270-307

Product Name: Adams Plus Flea and Tick Mist with Insect Growth Regulator

• Active Ingredient(s)
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • Guarantee/concentration 1 %
  • PYRETHRINS
    • Guarantee/concentration .18 %
  • PYRIPROXYFEN
    • Guarantee/concentration .125 %

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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 15, 2010 the owner sprayed an unknown amount of the product onto the cat.

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

Male

6. Age (provide a range if necessary )

10

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>8 hrs <= 24 hrs / >8 h <= 24 h

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Paralysis
  • Specify - Hind Limb Paralysis

• Respiratory System
  • Symptom - Abnormal lung sounds
  • Specify - Harsh Respiratory Sounds

• Nervous and Muscular Systems
  • Symptom - Collapse

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

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 16, 2010 the cat collapsed and started having hind limb paralysis. The owner then took the cat to the veterinarian. The attending veterinarian contacted the Animal Product Safety Service (APSS). The cat died during the APSS consultation. The attending veterinarian stated she suspects saddle thrombus secondary to cardiomyopathy.

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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 not considered to be related to causing the clinical situation. On July 19, 2010 an APSS veterinarian called the attending veterinarian to find out if the body is still available. The attending veterinarian stated the body was not available and a gross post mortem exam was not done to ascertain any potential cause of death.