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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-7716

2. Registrant Information.

Registrant Reference Number: 170208145

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: TEXAS

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. 270-349

Product Name: Adams Plus Pyrethrin Dip With Aloe Vera Extract For Dogs and Cats

  • Active Ingredient(s)
      • Guarantee/concentration 1.94 %
      • Guarantee/concentration 5.7 %
      • Guarantee/concentration 3.74 %
      • Guarantee/concentration .97 %

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

Cat / Chat

3. Breed

Domestic Shorthair

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?

>24 hrs <=3 days / >24 h <=3 jours

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Adipsia
  • Renal System
    • Symptom - Inappropriate urination
  • 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?

Treatment / Traitement

17. Provide any additional details about the incident

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

On November 27, 2017 the caller's mother thought she was administering dewormer to a stray cat she took in, but instead gave this product orally. Shortly after ingesting the product, the cat had an isolated event of vomiting. Later in the evening, the cat developed lethargy. In the morning on November 28, 2017, the cat developed anorexia and adipsia. At an unknown date and time, the cat had an isolated event of inappropriate urination. A few hours later on November 28, 2017, the caller contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated that the risk is for vomiting, diarrhea, less likely central nervous system (CNS) signs like ataxia, tremors. The APSS assistant recommended the caller take the animal to a veterinarian, have the veterinarian call for information, and to call back with questions.

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 not considered to be related to causing the clinical situation. A few hours later on November 28, 2017, the caller contacted the APSS with an update. The caller stated they took the cat to a clinic but the veterinarian was in surgery. The regular veterinarian recommended the caller give Pedialyte. The APSS veterinarian recommended the caller take the cat to a different veterinarian. On November 29, 2017 the caller contacted the APSS to update the case. The caller stated that the cat passed away on the evening of November 28, 2017. The APSS veterinarian stated that they would not expect death to occur from this exposure (especially in the absence of tremors or trembling). The APSS veterinarian further stated that signs that certainly could be seen include vomiting and hypersalivation, as well as tremors and potentially seizures. A necropsy was unavailable and the cat was buried soon after. APSS Report #.