Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-3986

2. Registrant Information.

Registrant Reference Number: 150107856

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.

07-AUG-15

5. Location of incident.

Country: UNITED STATES

Prov / State: OHIO

6. Date incident was first observed.

31-JUL-15

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. 270-294

Product Name: Bronco Water Base Equine Fly Spray Plus Citronella Scent

• Active Ingredient(s)
  • PERMETHRIN
    • Guarantee/concentration .1 %
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration .5 %
  • PYRETHRINS
    • Guarantee/concentration .05 %

---

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: Unknown / Inconnu

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

On an unknown date and continued to an unknown date the product was used. The owner stated the product was sprayed on a regular basis.

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Saint Bernard

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2.0

7. Weight (provide a range if necessary )

80.0

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Adipsia

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Diarrhea

• Renal System
  • Symptom - Renal failure

• 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?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Unknown

17. Provide any additional details about the incident

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

On July 31, 2015 the dog developed anorexia, adipsia, vomiting, and diarrhea. On August 3, 2015 the owner took the dog to the veterinarian, where the dog was diagnosed with renal failure; with a blood urea nitrogen of 299.0 milligrams per deciliter (mg/dL), serum creatinine of 20.0 mg/dL, and serum phosphorus of 25.0 mg/dL. The attending veterinarian then started fluid therapy, supportive care, and symptomatic care. Later that night, the dog died. On August 7, 2015 the attending veterinarian called the Animal Product Safety Service (APSS). The attending veterinarian stated that this dog had not been seen by the clinic before and there was an unknown history. The APSS veterinarian stated dermal exposure could result in dermal irritation (as with any topical exposure) or paresthesia. The APSS veterinarian also stated ingestion could result in gastrointestinal (GI) upset and hypersalivation. The APSS veterinarian discussed that the product's ingredients will not cause renal failure.

---

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 7, 2015 the APSS veterinarian realized that the product was labeled for use in dogs, so she called the veterinary clinic back and left a message letting them know that the manufacturer would offer a necropsy if the body is preserved well. On August 13, 2015 an APSS technician called the clinic to discuss the necropsy and left a message. On August 14, 2015 the attending veterinarian returned the call to the APSS. The APSS veterinarian stated that the manufacturer would have offered a necropsy. The attending veterinarian stated that the clinic has paid for a necropsy and the results are pending.