Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-1003

2. Registrant Information.

Registrant Reference Number: 32506

Registrant Name (Full Legal Name no abbreviations): Benchmark Animal Health Limited

Address: Highdown House, Yeoman Way

City: Worthing

Prov / State: West Sussex

Country: United Kingdom

Postal Code: S35 1QN

3. Select the appropriate subform(s) for the incident.

Packaging Failure

4. Date registrant was first informed of the incident.

22-NOV-22

5. Location of incident.

Country: CANADA

Prov / State: NEWFOUNDLAND

6. Date incident was first observed.

21-NOV-22

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. 32506      PMRA Submission No.       EPA Registration No.

Product Name: Salmosan Vet

• Active Ingredient(s)
  • AZAMETHIPHOS

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

.2

Units: ppm

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

Site: Other / Autre

Préciser le type: Aquaculture Site

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

Application rate is for end product and not the TGAI

To be determined by Registrant

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

Yes

Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Water soluble / Hydrosoluble

2. Did packaging failure occur during?

Use of Product

3. Did packaging failure result in?

potential exposure

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

Water soluble sachet was observed as unsealed when the box was opened. It is unknown if this happened during manufacturing, shipping or storage.

For Registrant use only

5. Provide supplemental information here.

Benchmarks QA investigation concluded that this was an isolated incident.