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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5543

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15098610

Registrant Name (Full Legal Name no abbreviations): Syngenta Crop Protection

Address: 410 Swing Road

City: Greensboro

Prov / State: North Carolina

Country: USA

Postal Code: 27419

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

Domestic Animal

4. Date registrant was first informed of the incident.

11-JUL-07

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

09-JUL-07

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.       PMRA Submission No.       EPA Registration No. 100-1000

Product Name: Demon WP in Water-Soluble Packets - EPA: 100-1000

  • Active Ingredient(s)
    • CYPERMETHRIN
      • Unknown

7. b) Type of formulation.

Wettable or soluble powder

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Res. - Out Home / Rés - à l'ext.maison

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Pit Bull Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.25

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

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

  • General
    • Symptom - Death
  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Bloody vomit
    • Symptom - Anorexia

12. How long did the symptoms last?

Persisted until death

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Not recovered / Non rétabli

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

Caller states they applied this product on their lawn 2 days ago. She thinks their 3 month old 15lb Pit Bull dog may have gotten some of the product on his paws and licked it off on the day of application (7/9/07). Yesterday (7/10/07) the dog began throwing up continually, and today it has stopped eating. The caller states that she has been giving the dog Pedialyte. Caller states that they do not take their animals to a vet because of financial constraints. Caller is convinced that they dog's symptoms are due to this product. Assessment: - Ingestions of small quantities of this product are unlikely to result in significant problems but if enough is ingested minor GI upset including nausea, vomiting and diarrhea may result. - I agree with your choice to offer pedialyte, we usually recommend giving a 1/2 and 1/2 mixture of pedialyte and water. - Because the vomiting has been significant and has persisted for more than 24 hours, and this is a small puppy, I highly recommend that you take your dog in to the vet. - Please call back if any additional concerns or questions arise 07/13/07 Follow-up The dog was not taken to the DVM. The dog began vomiting blood and died about 3 hrs after talking to H&S. She believes the product caused the symptoms and death. Assessment: Given sympathies on the death of the dog. Reviewed the product info given during initial call. Unlikely the product would have caused the death if the product was used as directed. There are many things like diseases, infections, rodenticide ingestions that could cause those symptoms and death.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Although the active ingredient is registered in Canada, the product is not and neither is this use.