Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-1935

2. Registrant Information.

Registrant Reference Number: 2024-46

Registrant Name (Full Legal Name no abbreviations): BASF Canada Inc.

Address: 5025 Creekbank Road, Building A, 2nd Floor

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L4W 0B6

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

13-MAR-24

5. Location of incident.

Country: UNITED STATES

Prov / State: ARIZONA

6. Date incident was first observed.

12-MAR-24

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 7969-382

Product Name: Selontra Rodent Bait

• Active Ingredient(s)
  • CHOLECALCIFEROL
    • Guarantee/concentration .075 %

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7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

No

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

Australian Blue Heeler

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

.75

7. Weight (provide a range if necessary )

23

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

• General
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Vomiting

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

The caller had a block of the product from their work left in their pocket. The pet was reported on March 11, 2024 to have ingested the block at an unknown time but possibly in the last 24 hours. The pet was reported to have vomited the evening of March 10, 2024. The caller communicated they were taking the dog to the vet for evaluation. The dog passed away on March 12, 2024.

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To be determined by Registrant

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

Death

19. Provide supplemental information here

The information contained in this report is based on self-reported statements provided to the registrant during telephone interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and cannot form the basis for a determination of whether the reported effects are causally related to exposure to the product identified in the telephone interviews. The information contained in this report does not admit any association between the pesticide and the reported effect(s).