Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4892

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-24053915

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.

09-SEP-10

5. Location of incident.

Country: UNITED STATES

Prov / State: KENTUCKY

6. Date incident was first observed.

09-SEP-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. 100-1050

Product Name: Talon-G rodenticide bait pack mini pellets

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

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7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Unknown

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

Mixed breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.16

7. Weight (provide a range if necessary )

5

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Vomiting

• 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.

Yes

14. a) Was the animal hospitalized?

Unknown

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

1-24053915- The reporter, a pet owner, calls to indicate possible exposure of his animal to a rodenticide that containing the active ingredient brodifacoum. The caller indicates his two month five to ten pound mixed breed dog had become lethargic and started vomiting with 24 hours of the initial contact with the registrant. The owner stated the animal may have ingested the product one day prior to the initial contact with the registrant but indicated he observed no ingestion. The caller does not specify whether the animal had exposure to an application area or access to the container of the product. The caller was advised of ingestions that might be actionable, symptoms that might be encountered, expected onset of those symptoms, treatment protocols, and prognosis. On follow-up the caller advised the registrant that the animal was brought to the veterinarian and administered Vitamin K1as a precaution. The animal was eventually diagnosed with parvovirus. According to the owner the animal developed dehydration, vomiting, diarrhea, refused food, and eventually died secondary to the parvoviral infection. No further information is available.

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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

No evidence of exposure. Animal died due to parvo virus.