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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3466

2. Registrant Information.

Registrant Reference Number: Prosar 1-19536426

Registrant Name (Full Legal Name no abbreviations): Syngenta Crop Protection Canada, Inc.

Address: 140 Research Lane, Research Park

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.

14-AUG-09

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

14-AUG-09

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. 100-990

Product Name: Demon WP

  • Active Ingredient(s)
    • CYPERMETHRIN
      • Guarantee/concentration 40 %

7. b) Type of formulation.

Wettable or soluble powder

Application Information

8. Product was applied?

No

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

Dog / Chien

3. Breed

Chihuahua

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

6

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Bloody diarrhea
  • 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?

Yes

14. b) How long was the animal hospitalized?

6

Hour(s) / Heure(s)

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Exposure assumed to be accidental ingestion, but there were no holes in the bag through which the product could have been accessed

17. Provide any additional details about the incident

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

1-19536426: A reporter (dog owner) called on 08/14/2009 to report the possible exposure of her dog to an insecticide containing the active ingredient Cypermethrin. According to the reporter, 2 hours prior to the report the dog was found chewing on the bag of product. Teeth marks were noted on the bag, but no holes were seen. At the time of the report, the dog was having bloody diarrhea. The reporter was advised that the signs are not consistent with the exposure described. A recommendation was made to have the dog evaluated immediately to determine the cause of the signs. On follow up, the reporter stated that the dog was evaluated by a veterinarian on 08/15/2009. The dog received unknown treatment and the reporter was instructed to transfer the dog to the emergency clinic for overnight care and continued treatment. The dog died en route to the emergency clinic. No further information was obtained.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Actual product exposure is unlikely. There were teeth marks in the product packaging but no holes through which the product may have been accessed. Product is no longer a registration of Syngenta.