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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5272

2. Registrant Information.

Registrant Reference Number: 100130697

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.

07-OCT-10

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

07-OCT-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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 270-343

Product Name: Adams Flea and Tick Mist Insecticide Repellent and Deodorant

  • Active Ingredient(s)
    • DI-N-PROPYL ISOCINCHOMERONATE
      • Guarantee/concentration .5 %
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Guarantee/concentration .51 %
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration 1.5 %
    • PYRETHRINS
      • Guarantee/concentration .15 %

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 October 7, 2010 the attending veterinarian applied the product to the puppy.

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

American Pit Bull Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.096

7. Weight (provide a range if necessary )

5

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Hypothermia
    • Symptom - Lethargy
  • Blood
    • Symptom - Anemia
  • General
    • Symptom - Parasitism
    • Specify - Flea Infestation
    • 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 October 7, 2010 the attending veterinarian realized that the product label stated the product should be used on dogs 12 weeks and older, so the attending veterinarian bathed the puppy in universal shampoo shortly after the exposure. The attending veterinarian then contacted the Animal Product Safety Service (APSS). The APSS veterinarian discussed risk of mild skin irritation and stated the anemia is likely due to flea infestation and the hypothermia possibly from the bath and anemia. The APSS veterinarian also stated the patient may also have a mild alcohol toxicosis due to the product's formulation. The APSS veterinarian recommended supportive and symptomatic care, fluid therapy, thermoregulation, calling back with questions, and obtaining additional information. The puppy died during the APSS consultation.


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 medium likelihood of causing the clinical situation. Multiple attempts to update the case were unsuccessful.