Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3533

2. Registrant Information.

Registrant Reference Number: 130085977

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.

25-JUN-13

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

22-JUN-13

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. 13438      PMRA Submission No.       EPA Registration No.

Product Name: Farnam Roll On Fly Repellent And Insecticide For Horses Ponies

• Active Ingredient(s)
  • DI-N-PROPYL ISOCINCHOMERONATE
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
  • PIPERONYL BUTOXIDE
  • PYRETHRINS

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7. b) Type of formulation.

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 June 22, 2013 the owner applied the product to the horse as a preventative.

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

Horse / Cheval

3. Breed

Quarter Horse

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

17.0

7. Weight (provide a range if necessary )

1000.0

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

• Skin
  • Symptom - Edema
  • Symptom - Other
  • Specify - Warm Skin
  • Symptom - Cracked skin
  • Symptom - Other
  • Specify - Purulent Discharge
  • Symptom - Erythema
  • Symptom - Hair loss

12. How long did the symptoms last?

Unknown / Inconnu

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

Not recovered / Non rétabli

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 June 23, 2013 the owner noticed that the horse had edema starting at the base of the ears and going down, had warm skin on her head, had cracked skin on the face and ears, and had yellow purulent discharge coming from the splits in the skin; the owner thought it looked like there might be pus. That day, the owner provided symptomatic care by applying a warm compress each day, giving Zincofax, and increasing the dosage of Bute to twice a day. On June 24, 2013 the owner noticed that the horse had erythema and alopecia. On June 25, 2013 the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that dermal reactions would be possible due to either the active ingredients or the carriers. The APSS assistant recommended that the owner wash the horse's face if she would tolerate it, discontinue product usage, consult her regular veterinarian to discuss the option of starting oral antibiotics, discontinue the topical Zincofax, limit the horse's exposure to sunlight if the lighter areas of the coat seemed to be more affected, and call back with questions.

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To be determined by Registrant

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

Minor

19. Provide supplemental information here

The APSS veterinarian stated that the substance was considered to have a medium likelihood of causing the clinical situation. On July 5, 2013 the owner contacted the APSS to update the case. The owner stated that she had washed the horse's face, discontinued product usage, and consulted with her veterinarian on June 25, 2013. The owner stated that on June 24, 2013 she started giving daily 2-scoop doses of Butorphanol Tartrate to the horse and at an unknown time the owner also applied a fly mask to the horse to protect her skin. The owner asked if she can apply a non-scented zinc ointment to the skin to help protect it; the APSS veterinarian stated that would be ok as long as the horse cannot lick it. The owner stated that the horse's signs continued. The APSS assistant recommended that the owner monitor the horse at home, have her regular veterinarian check on the horse if she had any changes in appetite or a fever, and call back with questions.