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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-1405

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-32297384

Registrant Name (Full Legal Name no abbreviations): Syngenta 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.

17-DEC-12

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

16-DEC-12

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?

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

Boxer

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.33

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

  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Vomiting
    • Symptom - Bloody diarrhea
  • 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

1-32297384 - The reporter, a pet owner, indicated that her dog was exposed to a rodenticide containing the active ingredient brodifacoum. The reporter indicated that her 30 pound, 4-month-old, Boxer ingested the product in the evening one day prior to initial contact with the registrant and soon after the dog suffered from diarrhea. The reporter also indicated that she just adopted the puppy and she thinks that the dog was sick prior to adoption: The dog had been vomiting for 3-4 days prior to initial contact. The reporter does not know if the puppy is up to date on vaccines. The reporter was advised that symptoms from product exposure would not be expected for 2-5 days after product exposure and to seek veterinary care. On follow-up, one day later, the reporter indicated that on the evening of initial contact her puppy suffered from bloody diarrhea and then shortly after that died. The reporter did not seek veterinary care for her dog. The reporter was advised that it is unlikely that the dogs illness was from product exposure since symptoms first developed prior to contact with the product. The reporter was further advised that the described symptoms may are seen with parvovirus a disease that is seen in young puppies. 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