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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-5543

2. Registrant Information.

Registrant Reference Number: 160130558

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.


5. Location of incident.


Prov / State: OREGON

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 270-373

Product Name: Just One Bite II Bar 16 oz For Use In And Around Agricultural Building

  • Active Ingredient(s)
      • Guarantee/concentration .005 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform III: Domestic Animal Incident Report

1. Source of Report


2. Type of animal affected

Dog / Chien

3. Breed

Border Collie

4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms


  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
  • Respiratory System
    • Symptom - Laboured breathing
  • Eye
    • Symptom - Bloodshot eye
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


16. How was the animal exposed?

Other / Autre

specify Relay

17. Provide any additional details about the incident

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

On August 31, 2016 the owner suspects that the dog ingested a dead rat that may have been exposed to the product. The dog could have had access to the bait the day before, although no known exposure is known as dog is allowed to roam outside where many bars were used around the property. The dog developed lethargy, anorexia, labored breathing, bloodshot eyes. The bloodshot eyes resolved later that evening. On September 1, 2016 the owner's caregiver called the Animal Product Safety Service (APSS). The APSS veterinarian stated a bleeding diathesis is possible 72 hours from the time of exposure. The APSS assistant recommended taking the dog to the veterinarian and having the veterinarian call for information. The APSS assistant discussed the severity of the situation. The caller stated she would discuss it with the owner, but the caller didn't sound like they will be able to take the dog into the clinic. The APSS assistant again mentioned that this could be fatal and the caller is aware.

To be determined by Registrant

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


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 September 5, 2016 the APSS assistant called the owner's caregiver for an update. The owner's caregiver stated that the dog died on September 2, 2016 and they did not take the dog to the veterinarian for any treatment. The APSS assistant relayed the APSS veterinarian's recommendation for a necropsy, but the dog's body had been buried a couple of days ago.