Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2460

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16074296

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

Address: 140 Research Lane

City: Guelph

Prov / State: Ontario

Country: Canada

Postal Code: N1G4Z3

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

Domestic Animal

4. Date registrant was first informed of the incident.

26-APR-08

5. Location of incident.

Country: UNITED STATES

Prov / State: TENNESSEE

6. Date incident was first observed.

26-APR-08

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 (non-specific)

• Active Ingredient(s)
  • BRODIFACOUM
    • Guarantee/concentration .005 %

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7. b) Type of formulation.

Bait

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).

On 4/26/08, the reporter stated that the dog had consumed up to 6 or 8 oz. of the bait sometime within the last couple days.

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

Golden Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1.67

7. Weight (provide a range if necessary )

12

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Respiratory System
  • Symptom - Panting

• General
  • Symptom - Lethargy
  • 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

Died

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

1-16074296: The reporter called on 4/26/08 to report his 14 week old puppy had consumed up to 6 or 8 ounces (168-224 grams) of rodenticide sometime within the last couple days. The rodenticide contained the active ingredient Brodifacoum. The reporter stated the puppy had become lethargic and seemed to have trouble breathing (panting). The toxic profile of the product was discussed as well as the puppy's toxic dose (2 grams). An assessment was made that this was a life threatening situation and that the puppy required immediate medical attention. A follow-up call on 4/28 revealed that the puppy had not been taken in to a veterinarian and had been found dead the next day (4/27).

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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