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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-0452

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-24825739

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.

29-NOV-10

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

29-NOV-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. 100-1050

Product Name: Talon-G rodenticide bait pack mini pellets

  • 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).

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

Female

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

15

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Vomiting
    • Symptom - Salivating excessively
    • Symptom - Diarrhea
  • Nervous and Muscular Systems
    • Symptom - Muscle weakness
  • Gastrointestinal System
    • Symptom - Bloody stool
  • 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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-24825739- The reporter, a pet owner, indicates her animal was exposed to a rodenticide containing the active ingredient brodifacoum. The pet owner indicates she rescued a stray female mixed breed fifteen pound dog from a local gas station. She indicated she placed the animal in her car port/garage three days prior to her initial contact with the registrant. The animal may have eaten as much as a full 25 mg package of the product the first night as the contents were missing and the dog had access to the product. No ingestion was observed. The animal was demonstrating the signs of anorexia, vomiting drooling, diarrhea and not wanting to hold its hind quarters up at the time of the initial contact with the registrant. The pet owner was advised of an actionable ingestion, standards of care, and prognosis. She was advised to seek prompt veterinary assistance. On routine follow up the pet owner indicated the animal had died. It was found the day after she had first contacted the registrant dead bleeding from the rectum. No veterinary assistance had been sought.


To be determined by Registrant

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

Death

19. Provide supplemental information here