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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-0888

2. Registrant Information.

Registrant Reference Number: 110010152

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.


5. Location of incident.


Prov / State: CALIFORNIA

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 270-255

Product Name: Apache Fly Bait

  • Active Ingredient(s)
    • (Z)-9-TRICOSENE
      • Guarantee/concentration .025 %
      • Guarantee/concentration 1 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.

10. Site pesticide was applied to (select all that apply).

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Labrador Retriever

4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Vomiting
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
    • Symptom - Seizure
  • Gastrointestinal System
    • Symptom - Diarrhea
  • Nervous and Muscular Systems
    • Symptom - Unconsciousness
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?


15. Outcome of the incident


16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

On January 24, 2011 the owner took the dog to the regular veterinarian, who noticed the dog had tremors, seizures, and was unconscious. Shortly after, the regular veterinarian gave the dog Atropine, fluid therapy, and Diazepam. That day, the dog was transferred to an emergency veterinary clinic. Shortly after arriving at the emergency clinic, the emergency veterinarian contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that it was necessary to competitively inhibit acetylcholinesterase (AchE) by binding to its esteric site. The APSS veterinarian further stated that without AchE, Ach accumulates and causes excessive synaptic neurotransmitter activity. The APSS veterinarian went on to state that because carbamates bind with acetylcholine on a reversible basis, the inhibition of acetylcholinesterase is temporary, and thus carbamates have a shorter duration of action than organophosphate insecticides. The APSS veterinarian further stated that any exposure to the product can cause clinical signs and that the muscarinic signs include the SLUD signs (excessive salivation, lacrimation, urination, and defecation) as well as miosis, dyspnea, vomiting, and bradycardia. The APSS veterinarian stated that dyspnea is the result of increased bronchial secretions, bronchoconstriction, and decreased contraction of the respiratory muscles. Finally, the APSS veterinarian stated that common signs are tremors, seizures, hypersalivation, vomiting, and ataxia, and that one might also see diarrhea, hyperthermia, lethargy, miosis, and death. Later that day, the dog began vomiting and developed diarrhea. The APSS veterinarian recommended giving the dog Methocarbamol, Diazepam, Barbiturate, and fluid therapy. The APSS veterinarian also recommended managing the seizures and tremors, monitoring for respiratory sounds, heart rate and rhythm, and for signs of aspiration, managing vomiting, supporting respiratory function, monitoring the dog at a veterinary facility, and obtaining additional information about the owner and the exposure to the product. The APSS veterinarian also stated that the dog had received a large amount of atropine and that further administration was not recommended.

To be determined by Registrant

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


19. Provide supplemental information here

The APSS veterinarian stated that the substance was considered to have a high likelihood of causing the clinical situation. On January 24, 2011, the APSS veterinarian called the emergency veterinary clinic to update the case and found out that the emergency veterinarian performed a gastric lavage. On January 26, 2011 an APSS assistant called the emergency veterinary clinic to update the case and found out the dog died on the morning of January 25, 2011.