Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2368

2. Registrant Information.

Registrant Reference Number: 130026279

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.

01-MAR-13

5. Location of incident.

Country: UNITED STATES

Prov / State: MISSISSIPPI

6. Date incident was first observed.

Unknown

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. 270-343

Product Name: Adams Flea And Tick Mist Insecticide Repellent And Deodorant For Dogs

• 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 %

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

No

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Labrador Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

4.0

7. Weight (provide a range if necessary )

80.0

lbs

8. Route(s) of exposure

Oral

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 - Grass ingestion

• Nervous and Muscular Systems
  • Symptom - Abnormal posture

• Gastrointestinal System
  • Symptom - Drooling

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Abasia
  • Specify - arched back

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

Between February 25 and February 27, 2013 the owner noticed that the dog was eating grass. In addition, the owner noticed that there was a Adams Flea and Tick Mist Insecticide Repellent and Deodorant bottle chewed and punctured in the yard. On the morning of March 1, 2013 the owner noticed that the dog's back was arched significantly and the dog was sucking in her stomach significantly; the owner also noticed that the dog was drooling. Several hours later that morning, the owner discovered that the dog had died while unattended. Later that day, the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that the product is a low concentration pyrethroid and that ingestion of the contents of the bottle would be expected to cause mild to marked drooling due to the bad taste; this would develop almost immediately and should resolve shortly. The APSS veterinarian also stated that this was not a serious exposure, even if a couple of ounces were licked up. The APSS veterinarian recommended that the owner have a necropsy performed to determine the cause of the dog's death and that the owner's veterinarian call for information if a necropsy were being pursued.

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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 the evening of March 1, 2013 an APSS technician called the owner to discuss a necropsy. The owner stated that the dog's body had been disposed of and was not available for necropsy.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Shetland Sheepdog Mix

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

16.0

7. Weight (provide a range if necessary )

15.0

lbs

8. Route(s) of exposure

Oral

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 - Grass ingestion

• Nervous and Muscular Systems
  • Symptom - Abnormal posture

• Gastrointestinal System
  • Symptom - Drooling

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Abnormal posture
  • Specify - arched back

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

Between February 25 and February 27, 2013 the owner noticed that the dog was eating grass. In addition, the owner noticed that there was a Adams Flea and Tick Mist Insecticide Repellent and Deodorant bottle chewed and punctured in the yard. On the morning of February 28, 2013 the owner noticed that the dog's back was arched significantly and the dog was sucking in her stomach significantly; the owner also noticed that the dog was drooling. Several hours later that morning, the owner discovered that the dog had died while unattended. On March 1, 2013 the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that the product is a low concentration pyrethroid and that ingestion of the contents of the bottle would be expected to cause mild to marked drooling due to the bad taste; this would develop almost immediately and should resolve shortly. The APSS veterinarian also stated that this was not a serious exposure, even if a couple of ounces were licked up. The APSS veterinarian recommended that the owner have a necropsy performed to determine the cause of the dog's death and that the owner's veterinarian call for information if a necropsy were being pursued.

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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 the evening of March 1, 2013 an APSS technician called the owner to discuss a necropsy. The owner stated that the dog's body had been disposed of and was not available for necropsy.