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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-5656

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-54088172

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.

25-SEP-18

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

21-SEP-18

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 + 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

German Shepherd

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

75

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 - Anorexia
  • General
    • Symptom - Lethargy
    • Symptom - Pale mucous membrane colour
  • Gastrointestinal System
    • Symptom - Abdominal distension
  • Blood
    • Symptom - Anemia
    • Specify - low red blood cell count

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

Unknown/Inconnu

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

1-54088172 - The reporter, a pet owner, indicates an exposure to a pesticide containing the active ingredient brodifacoum. Four days before the day of initial contact with the registrant, the reporter indicated his 5-year-old, 75-pound, male German Shepherd dog experienced lethargy and anorexia which persisted through the time of initial contact. The reporter suspected the dog ingested an unknown amount of the product an unknown number of days before the symptoms occurred. The reporter was advised to seek immediate veterinary care for the dog as the symptoms could be related to ingestion of a toxic amount of the product. On follow-up call two days after initial contact, the reporter was not available. On follow-up call three days after initial contact, the reporter indicated he sought veterinary care for the dog who now also had pale gums, a swollen abdomen, and a low red blood cell count. The reporter stated the dog was currently at home. The reporter was advised to get immediate veterinary care for the dog. No additional 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