Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7271

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15331907

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.

29-AUG-07

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

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.       PMRA Submission No.       EPA Registration No.

Product Name: Weatherblok - Non Specific

• Active Ingredient(s)
  • BRODIFACOUM
    • Unknown

---

7. b) Type of formulation.

Bait

Granular

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).

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

Unknown Breed

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

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 - Death

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?

Other / Autre

specify Possible secondary exposure to Rodents

17. Provide any additional details about the incident

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

History: Caller received a letter from a lady that said her cat died and the veterinarian reportedly indicated an anticoagulant was involved. The lady checked the neighborhood and the only house that was using rat bait was a house treated by caller. Caller used Weatherblok and only put them in bait stations. He has seen very little feeding and not observed any dead rats in he area. Information Provided: According to the experts and our experience it is highly unlikely that the cat died from eating mice or rats which ingested Brodifacoum. I supplied the letter on secondary poisoning written by the rodent expert, and asked caller to let me know if he received any other information on the cat death.

---

To be determined by Registrant

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

Death

19. Provide supplemental information here