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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-1937

2. Registrant Information.

Registrant Reference Number: 170046334

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.



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.


Units: oz (wts) / oz (pds)

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 March 23, 2017 the owner discovered the entire contents of the bait had been chewed into and ingested.

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

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed


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


  • Nervous and Muscular Systems
    • Symptom - Recumbent
    • Specify - Inability to Stand
  • 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.


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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

When the owner returned home on March 23, 2017 he noticed the dog was unable to stand. Sometime within the night, the dog started vomiting. The owner does not recall seeing any of the bait in the vomit. When the owner woke up in morning on March 24, 2017, he found the dog was deceased. The owner notes that he also hunts deer and the dog may have been exposed to a carcass but there is no evidence of an exposure. On March 24, 2017 the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated that this agent is a second generation anticoagulant and that the common signs include lethargy, depression, bleeding from nose or rectum, and internal bleeding. The APSS veterinarian stated that signs usually develop 3-5 days post exposure and that the time frame of signs doesn't seem to fit with this exposure. The APSS veterinarian recommended a necropsy and to take the other animals involved to a veterinarian.

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. An APSS technician called the owner to inquire about a necropsy on March 27 and March 29, 2017. A voicemail was not set up so no message could be left. At the time of this report, a necropsy is not pending.