Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2227

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-26034308

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.

03-MAY-11

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

Unknown

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. Unknown

Product Name: Ratak (non-specific)

  • Active Ingredient(s)
    • BRODIFACOUM

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

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

Cat / Chat

3. Breed

domestic shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

>1 yr / > 1 an

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Unknown

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?

Other / Autre

specify Relay toxicity possible ingestion of rodent killer by the product

17. Provide any additional details about the incident

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

1 26034308 The reporter, a pet owner, indicates his animal may have been exposed to a rodenticide containing the active ingredient brodifacoum. The pet owner indicated his male domestic shorthair cat had died the other day the caller was unable to be specific. He indicated no symptoms prior to the animal s death and no veterinary consultation. He calls to ask if his pet had ingested a mouse that had consumed the product would the pet have been affected. He indicted no observed exposure and did not indicate if the animal had exposure to an application area. The caller was advised relay or secondary toxicosis involving rodenticides is rare and unlikely. It would not be expected and is inconsistent with a single acute exposure or ingestion of a single rodent that had consumed the active ingredient. No further information is available.


To be determined by Registrant

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

Death

19. Provide supplemental information here