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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3252

2. Registrant Information.

Registrant Reference Number: 120111144

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-AUG-12

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

08-AUG-12

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. 270-324

Product Name: Adams Flea And Tick Cleansing Shampoo For Dogs Puppies Cats

  • Active Ingredient(s)
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration .75 %
    • PYRETHRINS
      • Guarantee/concentration .075 %
    • PYRIPROXYFEN
      • Guarantee/concentration .086 %

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 August 7, 2012 the owner applied the product to the dog and left it on him.

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

Pomeranian

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

11.0

7. Weight (provide a range if necessary )

6.0

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • Respiratory System
    • Symptom - Laboured breathing
    • Symptom - Coughing
  • Gastrointestinal System
    • Symptom - Anorexia
  • Respiratory System
    • Symptom - Abnormal lung sounds
    • Specify - Harsh Respiratory Sounds
  • 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 August 8, 2012 the owner noticed that the dog had labored breathing, was coughing, and was anorexic. Later that evening, the owner rinsed the dog's coat and skin. On the morning of August 9, 2012 the owner took the dog to the veterinarian, where a chemistry profile and diagnostic evaluation were performed; the radiographs revealed an interstitial pattern that was more pronounced in the right caudal area and the labwork was within normal limits. The regular veterinarian observed that the dog was making harsh respiratory sounds. A short time later, the owner's regular veterinarian contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that dermal irritation is possible and that if the product is ingested, gastrointestinal (GI) upset is possible. The APSS veterinarian also stated that mild mucosal irritation and pharyngeal edema are possible following ingestion of soaps, and that lower respiratory signs would not be expected unless the dog aspirated. The APSS veterinarian said that a topical exposure to pyrethrins can result in a tingling sensation (paresthesia). The APSS veterinarian recommended that the regular veterinarian perform a diagnostic evaluation, provide symptomatic and supportive care, and protect the gastrointestinal tract.


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 August 14, 2012 the owner called the APSS to update the case. The owner stated that on the evening of August 9, 2012 radiographs were taken and oxygen was given to the dog. The owner stated that the dog died at the veterinary school at the University of Georgia on August 11, 2012, before an exact diagnosis could be established. A necropsy was not available.