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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2395

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-40761095

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.

30-MAY-15

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW MEXICO

6. Date incident was first observed.

26-MAY-15

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: Unknown / Inconnu

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

Dachshund

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

8

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Cardiovascular System
    • Symptom - Tachycardia
  • Skin
    • Symptom - Pale mucous membrane colour
  • Respiratory System
    • Symptom - Shortness of breath
    • Specify - shallow breathing
  • General
    • Symptom - Death
  • Blood
    • Symptom - Anemia

12. How long did the symptoms last?

Persisted until death

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

Yes

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

1-40761095 - The reporter, a pet owner, indicated that his dog may have been exposed to a rodenticide containing the active ingredient brodifacoum. No exposure to the product was witnessed but the reporter indicated four days prior to initial contact with the registrant his 7-year-old, 8 pound dachshund had white gums, a racing heart and he was breathing shallowly. The dog was brought to the veterinarian where blood work showed a low red blood cell count. The dog was given a shot of vitamin K1 and sent home. The dog died at home three days after symptoms had started. 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