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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-0914

2. Registrant Information.

Registrant Reference Number: PROSAR 1-21692888

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.

17-FEB-10

5. Location of incident.

Country: UNITED STATES

Prov / State: ARKANSAS

6. Date incident was first observed.

15-FEB-10

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. 100-1057

Product Name: Talon-G rodenticide mini-pellets with bitrex

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

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: Res. - In Home / Rés. - à l'int. maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

The product was placed inside a residence at an unknown time.

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

Dachshund/maltese mix

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

19

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

  • Gastrointestinal System
    • Symptom - Nausea
  • General
    • Symptom - Lethargy
  • Respiratory System
    • Symptom - Difficulty Breathing
    • Symptom - Pleural effusion
    • Specify - "Blood in lungs"
  • 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?

Unknown

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

1-21692888: A reporter (dog owner) called on 02/17/2010 to report the exposure of her dog to an anticoagulant rodenticide containing the active ingredient Brodifacoum. According to the reporter, the dog had ingested up to 3/4 of the package on 02/15/2010. The dog developed nausea, lethargy, and difficulty breathing an unspecified time following ingestion. At the time of the report, the dog was at the veterinary clinic and had been diagnosed with blood in her lungs. The reporter was advised of the active ingredient, the mechanism of action of the product, and the dog's calculated toxic dose. Signs of anticoagulant rodenticide toxicity were reviewed. The reporter was advised that the antidote is Vitamin K1, and monitoring with PT blood tests was recommended. On follow up on 02/19/2010, the reporter stated that the dog died at the veterinary clinic on 02/18/2010. 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