Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-1968

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 2024SCPU00078139

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.

28-MAR-24

5. Location of incident.

Country: UNITED STATES

Prov / State: MINNESOTA

6. Date incident was first observed.

27-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. 100-1055

Product Name: TALON WEATHERBLOK XT

• Active Ingredient(s)
  • BRODIFACOUM
    • Guarantee/concentration .005 %

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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: Res. - Out Home / Rés - à l'ext.maison

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

Other

2. Type of animal affected

Dog / Chien

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

40

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

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?

Other / Autre

specify Possible accidental secondary exposure to pesticide via ingestion of a rodent that may have been exposed to this product

17. Provide any additional details about the incident

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

2024SCPU00078139 - The reporter, a pest control operator, suspects a possible exposure to a pesticide containing the active ingredient brodifacoum. The reporter indicated that an unknown amount of time before the day of initial contact with the registrant, an approximately 40 pound dog of unknown sex, age and breed may have ingested an unknown amount of the pesticide via possible ingestion of a rodent that may have been exposed to this product. One day before the day of initial contact the dog died suddenly before the owner could seek medical attention. No additional information is available.

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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 reporter indicates the product has been used in bait stations and there is no evidence that the dog was able to get to the bait in the bait stations directly.