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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2378

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-33101448

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.


5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


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.


PMRA Registration No. 21084      PMRA Submission No.       EPA Registration No.

Product Name: Weatherblock XT Bait Ratak + Rodenticide

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


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?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Australian Shepherd

4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms


  • Blood
    • Symptom - Abnormal coagulation

12. How long did the symptoms last?

Unknown / Inconnu

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


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


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

1-33101448 - The reporter, a pet owner, indicated that her dog may have been exposed to a rodenticide containing the active ingredient brodifacoum. The reporter indicated that on the day of initial contact her neighbor had seen her 40 pound, 9-month-old, Australian Shepherd in an area where some bait had been placed but ingestion of the bait was not observed. The reporter also indicated that her dog had access to the neighbors house two weeks prior to initial contact and may have ingested some bait at that time as well although that ingestion was not witnessed either. The reporter was advised to take her dog to the veterinarian where the antidote, vitamin K1, could be prescribed if needed. On follow-up call, two days later, the reporter indicated that she took her dog to the veterinarian one day after initial contact. The veterinarian measured her dogs prothrombin time, found that it was prolonged and started the dog on a 21 day course of vitamin K1. No further information is available.

To be determined by Registrant

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


19. Provide supplemental information here