Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-0366

2. Registrant Information.

Registrant Reference Number: 140125035

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.

02-OCT-14

5. Location of incident.

Country: UNITED STATES

Prov / State: HAWAII

6. Date incident was first observed.

01-JUL-14

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. 270-333

Product Name: Scratchex Flea and Tick Shampoo for Dogs and Cats

• Active Ingredient(s)
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • Guarantee/concentration .24 %
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration .144 %
  • PYRETHRINS
    • Guarantee/concentration .072 %

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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).

The owner purchased the kitten from a breeder that advertised him on ebay and the day she went to pick him up from the airport she noticed that he was still having dead fleas on him. The breeder told her that she used Scratchex shampoo on him on July 1, 2014.

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

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Persian

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.154

7. Weight (provide a range if necessary )

24.4

oz (wts) / oz (pds)

8. Route(s) of exposure

Skin

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 - Listless

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Other
  • Specify - Rectal Discharge
  • Symptom - Stomach pain
  • Specify - Abdominal Pain

• 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?

6

Hour(s) / Heure(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 July 1, 2014 the kitten became listless, started vomiting, and had rectal discharge on the way home. A few hours later, the owner took the kitten to the veterinary clinic, where they monitored the kitten at the veterinary facility and gave fluid therapy. Several hours later the kitten developed abdominal pain, then died a couple hours later. On October 2, 2014 the owner contacted the Animal Product Safety Service (APSS), wanting to know if the shampoo is the cause of death, as she is planning to sue the breeder. The APSS veterinarian stated the risk is for mild-moderate, self-limiting, dermal hypersensitivity/paresthesia ("pins and needles" feeling). The APSS veterinarian also stated there is potential for more severe signs if underlying pathology exists (e.g. anemia). A necropsy was not available.

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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

Product is considered to have a doubtful likelihood of causing the clinical situation. A follow up was not performed, because additional information was not expected.