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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-4519

2. Registrant Information.

Registrant Reference Number: 2011-09-19 B

Registrant Name (Full Legal Name no abbreviations): Syngenta Crop Protection Canada, Inc

Address: 140 Research Lane, Research Park

City: Guelph

Prov / State: ON

Country: Canada

Postal Code: N1G 4Z3

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

Scientific Study

4. Date registrant was first informed of the incident.

5. Location of incident.

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.

Active(s)

PMRA Registration No. 29642      PMRA Submission No. 2011-4005      EPA Registration No. 100-1347

Product Name: Concert Fungicide

  • Active Ingredient(s)
    • CHLOROTHALONIL
    • PROPICONAZOLE

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 VII: Scientific Study

1. Study Reference

Title Chlorothalonil/Propiconazole SE (A13817D) - Primary Eye Irritation in Rabbits

Date 15-MAR-11

2. a) Is an extension needed to translate the document?

No

3. Type of incident identified in the study

Increased health or environmental risk

4. Describe the incident identified in the study (e.g. study demonstrates an increased risk to non-Hodgkin's Lymphoma after exposure to pesticide X)

Different study endpoint.

5. a) Was the study discontinued before completion?

No

5. b) Provide the reason for discontinuation

6. If the study is ongoing, what is the expected completion date?

For Registrant use only

7. Provide supplemental information here