Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-4308
2. Registrant Information.
Registrant Reference Number: 120131823
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.
19-SEP-12
5. Location of incident.
Country: UNITED STATES
Prov / State: OHIO
6. Date incident was first observed.
17-SEP-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 Kittens
- 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 September 17, 2012 the owner bathed the cat with the shampoo product to treat 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
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Norwegian Forest Cat
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
8.0
7. Weight (provide a range if necessary )
17.0
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
<=15 min / <=15 min
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
No
14. a) Was the animal hospitalized?
No
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 September 17, 2012, about 10 minutes after the owner bathed the cat with the shampoo product, the owner observed that the cat died suddenly. On September 19, 2012 the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that the death of the cat was not at all consistent with the use of the shampoo product and that hypertropic cardiomyopathy would be suspected. However, as a necropsy was not available because the cat had already been buried, an exact cause of death could not be determined.
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 shampoo product was not considered to be related to causing the clinical situation and that hypertropic cardiomyopathy was considered to have an unknown likelihood of causing the clinical situation.