Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-4816

2. Registrant Information.

Registrant Reference Number: 150117820

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.

27-AUG-15

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW HAMPSHIRE

6. Date incident was first observed.

26-AUG-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)

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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).

On August 25, 2015 the owner used the product to treat a flea infested kitten.

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

Maine Coon

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.125

7. Weight (provide a range if necessary )

2.0

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• General
  • Symptom - Lethargy
  • Symptom - Vocalizing

• Gastrointestinal System
  • Symptom - Vomiting

• General
  • Symptom - Death

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 August 26, 2015 the kitten developed lethargy, vocalization, and vomiting. Later that day, the kitten died, cardiopulmonary resuscitation was attempted. On August 27, 2015 the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated the shampoo could cause mild tingling and paresthesia to the skin, but death would not be expected. The APSS veterinarian also stated even with large exposures to pyrethrins and pyrethroids, risks are for ataxia, tremors, and seizures. The APSS veterinarian finally stated suspect the kitten died from flea anemia, parasitism, and/or a viral infection.

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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.