Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2024-0132
2. Registrant Information.
Registrant Reference Number: 2024-01
Registrant Name (Full Legal Name no abbreviations): BASF Canada Inc.
Address: 5025 Creekbank Road, Building A, 2nd Floor
City: Mississauga
Prov / State: Ontario
Country: Canada
Postal Code: L4W 0B6
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
15-NOV-23
5. Location of incident.
Country: CANADA
Prov / State: NEW BRUNSWICK
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. 33424
PMRA Submission No.
EPA Registration No.
Product Name: SECLIRA COCKROACH GEL BAIT RESERVOIR
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
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).
A pest control operator called to report that a cat might have ingested the product after the bait was placed on November 9th or 10th 2023.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Cat / Chat
3. Breed
Domestic Shorthair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
6
7. Weight (provide a range if necessary )
15
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- General
- Symptom - Adipsia
- Specify - Decreased water intake
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
16. How was the animal exposed?
Other / Autre
specify possible accidental ingestion from the bait
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
The caller was unsure if the cat ingested the product. The cat was reported to be vomiting and have decreased water intake.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here