Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2586

2. Registrant Information.

Registrant Reference Number: PROSAR 1-22458158

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.

01-MAY-10

5. Location of incident.

Country: UNITED STATES

Prov / State: SOUTH DAKOTA

6. Date incident was first observed.

01-MAY-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)

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

Product Name: Ropax Bars

• Active Ingredient(s)
  • BRODIFACOUM
    • Unknown

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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).

According to the reporter, the dog may have consumed 1/2 of a bar of the anticoagulant rodenticide product on 4/30/10. However, the reporter did indicate the dog could also have ingested some bait prior to then. The dog started coughing up blood on 5/1/10.

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

Australian Cattle Dog

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

30

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 - Coughing up blood

• 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

Died

16. How was the animal exposed?

Other / Autre

specify The reporter thought the dog ingested the product; it is not known if the reporter actually witnessed the ingestion.

17. Provide any additional details about the incident

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

1-22458158: The reporter, an animal owner, called the registrant on 5/1/10 to report the exposure of his 1 year old male Australian Cattle Dog to an anticoagulant rodenticide containing the active ingredient Brodifacoum. According to the reporter, he thought the dog had ingested ¿ of a bar of product on 4/30. However, the reporter did indicate the dog may also have ingested some bait prior to then. The dog started coughing up blood on 5/1. During the call the reporter inquired about and was given information regarding the anticoagulant effects of the product. A recommendation was made to take the dog to a veterinarian immediately for treatment. It was discussed that treatment with vitamin K1 would be needed for 21-30 days or more. A follow-up call on 5/3 revealed that the dog had died the morning of 5/2/10. The reporter had contacted several veterinarians; he indicated that the only treatment they could offer was to euthanize the dog. The reporter did not seek veterinary attention elsewhere.

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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

According to the reporter, the dog may have consumed 1/2 of a bar of the anticoagulant rodenticide product on 4/30/10. However, the reporter did indicate the dog could also have ingested some bait prior to then. The dog started coughing up blood on 5/1/10.