Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-2656
2. Registrant Information.
Registrant Reference Number: 160060433
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.
29-APR-16
5. Location of incident.
Country: UNITED STATES
Prov / State: NEW MEXICO
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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 270-294
Product Name: Flea Halt Water Base Flea and Tick Spray for Dogs Plus Citronella
- 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: 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 April 5, 2016 and again on April 12, 2016 the owner applied the product onto the dog to treat for ticks.
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
Dog / Chien
3. Breed
Australian Shephard Dog
4. Number of animals affected
1
5. Sex
Male
Female
6. Age (provide a range if necessary )
0.5
7. Weight (provide a range if necessary )
Unknown
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
- Nervous and Muscular Systems
12. How long did the symptoms last?
Unknown / Inconnu
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
Unknown/Inconnu
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 an unknown date after the second application the dog started having seizures. On April 29, 2016 the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated agent contains pyrethrin and permethrin and is safe to use on cats and dogs and she would not expect any central nervous system (CNS) changes from this type of product or at this concentration. The APSS veterinarian also stated dermal exposures may cause mild dermal irritation and hyperesthesia within the first 24-48 hours, and possibly secondary alopecia from pruritus. The APSS veterinarian further stated oral exposures often result in hypersalivation, nausea, and possibly hiding because of the taste. The APSS veterinarian finally stated piperonyl butoxide is a synergist to enhance the efficacy of the ingredients.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Major
19. Provide supplemental information here
The APSS veterinarian stated that the substance was considered to have a doubtful likelihood of causing the clinical situation. A follow up was not performed, because additional information was not expected.