Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2014-4234
2. Registrant Information.
Registrant Reference Number: PROSAR case number: 1-37795180
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.
14-JUL-14
5. Location of incident.
Country: UNITED STATES
Prov / State: FLORIDA
6. Date incident was first observed.
Unknown
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: Dynasty PD treated peanut seeds
- Active Ingredient(s)
- AZOXYSTROBIN
- Guarantee/concentration 3.2 %
- FLUDIOXONIL
- Guarantee/concentration 2 %
- METALAXYL-M (MEFENOXAM)
- Guarantee/concentration .4 %
7. b) Type of formulation.
Other (specify)
Seed treatment
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
Medical Professional
2. Type of animal affected
Cow / Vache
3. Breed
Beef cow
4. Number of animals affected
2
5. Sex
Unknown
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
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?
Accidental ingestion/Ingestion accident.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-37795180 - The reporter, a veterinarian, indicated that 4 yearling beef calves were exposed to peanuts treated with a fungicide containing the active ingredients azoxystrobin, mefenoxam and fludioxonil. The reporter stated that the calves got into the product sometime within 48 hours of her initial call. At the time of her initial call two calves were found dead and two other calves were down and unable to rise. The reporter was advised that the amount of fungicide on the peanuts is very minimal and would not be expected to cause the described symptoms. A necropsy was recommended to help determine the cause of death. The reporter could not be reached on follow-up. 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