Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5544

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15069877

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.

03-JUL-07

5. Location of incident.

Country: UNITED STATES

Prov / State: TENNESSEE

6. Date incident was first observed.

27-JUN-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: Havoc Rodenticide

• Active Ingredient(s)
  • BRODIFACOUM
    • Unknown

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7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Unknown

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Horse / Cheval

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

1250

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>1 wk <=1 mo / > 1 sem < = 1 mois

11. List all symptoms

System

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Yes

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

Caller states her 2 horses were witnessed ingesting product 7 days ago by her children. Caller states while she is unsure of amount ingested by each horse, product is missing from its container and Little Bit was witnessed with 2 empty bait packages hanging from mouth 7 days ago. Caller states yesterday all of her horses were fine. Today caller states she found Little Bit had passed away in pasture. Caller is now concerned that the other horse that ingested product, Leo, is going to have adverse health effects too. Caller is looking for toxicity information. Assessment: I am sorry for your loss. Your horse could ingest up to (Leo 8.6oz or 260g) of bait before we would consider some form of treatment to be necessary. Given the history provided it is unlikely that Leo ingested enough of this product to be considered toxic. If more than the expected amount was ingested, signs to watch for include: difficulty breathing, lethargy, anorexia, ataxia, and evidence of bleeding in stool, urine, nasal secretions, and gums. If these signs develop consult you DVM. An antidote, Vitamin K1 is available. CB PRN. Rec that she could ask her DVM to examine horse, draw blood for a PT test, and give the initial dose of Vit K1 as a precautionary measure. I also stated that if she has further questions she can call back and ask for me or a DVM on staff. 07/090/07 Follow-up Speaking with Owner, who reports that Leo's has been fine. He did receive 3 days of injections of K1, and they are continuing to monitor. No testing was ever performed to verify the cause of Little Bit's demise. Case closed.

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To be determined by Registrant

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

Death

19. Provide supplemental information here