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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-1860

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-25374091

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.

13-FEB-11

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

13-FEB-11

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. 16064      PMRA Submission No.       EPA Registration No.

Product Name: Ratak + Rodenticide Pellets

  • Active Ingredient(s)
    • BRODIFACOUM

7. b) Type of formulation.

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

English Mastiff/ Bulldog

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

90

lbs

8. Route(s) of exposure

Oral

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

  • General
    • Symptom - Lethargy

12. How long did the symptoms last?

Unknown / Inconnu

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

Fully Recovered / Complètement rétabli

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

1-25374091- The reporter, a pet owner indicates his animal may have been exposed to a rodenticide containing the active ingredient brodifacoum. The pet owner indicated her ninety pound one year female Mastiff/Bulldog may have ingested the product within the past 24 hours. The animal owner indicated an empty packet of the product had been found on the barn floor torn open she was concerned it was ingested by her dog. Exposure was not observed. The pet owner stated she had contacted her veterinarian who had recommended induction of emesis with hydrogen peroxide. The pet owner had done this three times and had seen no bait in the vomitus. She now reported the animal was lethargic (nonspecific signs). The veterinarian had recommended the animal be further monitored for blood shot eyes and/or bruising. The pet owner was informed of current standards of care following ingestion of anticoagulant rodenticides in domestic animals. The pet owner was advised the ingestion described (calculation based on the animals body weight) could be problematic for the dog and advise to seek care. The same day the attending veterinarian called the registrant questioning the advice given. Calculations and current standards of care were reviewed with the veterinarian. On routine follow up with the owner it was indicated the animal had been given a course Vitamin K1 and its affect had improved. No further information is available.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here