Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2010-6008

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: PROSAR Case # 1-24614220

Nom du titulaire (nom légal complet, aucune abbréviation): Syngenta Crop Protection Canada, Inc.

Adresse: 140 Research Lane, Research Park

Ville: Guelph

État: Ontario

Pays: Canada

Code postal /Zip: N1G4Z3

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.

Incident chez un animal domestique

4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

04-NOV-10

5. Lieu de l'incident.

Pays: UNITED STATES

État: TENNESSEE

6. Date de la première observation de l'incident.

Inconnu

Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

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ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation. 100-1321

Nom du produit: Avicta Duo Cotton

• Matière active
  • ABAMECTIN
    • Garantie/concentration 12.4 %
  • THIAMETHOXAM
    • Garantie/concentration 28.1 %

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ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation. 100-1177

Nom du produit: Dynasty CST

• Matière active
  • AZOXYSTROBIN
    • Garantie/concentration 6.64 %
  • FLUDIOXONIL
    • Garantie/concentration 1.11 %
  • METALAXYL-M (MEFENOXAM)
    • Garantie/concentration 3.32 %

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7. b) Type de formulation.

Autre (préciser)

treated seed

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?

Non

9. Dose d'application.

10. Site d'application (choisir tout ce qui s'applique).

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?

Inconnu

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cow / Vache

3. Race

Angus

4. Nombre d'animaux touchés

1

5. Sexe:

Femme

6. Âge (fournir un ordre de grandeur si nécessaire)

Inconnu

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Inconnu

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

• General
  • Symptôme - Mort

12. Quelle a été la durée des symptômes?

Persisted until death

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Non

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Non

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Mort

16. De quelle manière l'animal a-t-il été exposé?

Accidental ingestion/Ingestion accident.

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-24614220- The reporter, a veterinarian, indicates exposure of four patients to cotton seed treated with the active ingredients abamectin, thiamethoxam, azoxystrobin, fludioxonil and mefenoxam. The caller reports three Angus cattle (Subform III, #2) have presented to him with the primary complaint of ataxia. He indicated the animals had possibly eaten an unknown amount of the product within the past 24-48 hours. He reported that one (or more) animal was dead on the farm (Subform III, #1). It was unknown when or how the animal died. No exposure was observed. On presentation the veterinarian had incomplete product identification information, it was impossible for the registrant to determine the active ingredient or product involved with the information provided. It was recommended the veterinarian obtain a more thorough history and product identification information and contact the registrant back for specific recommendations. The veterinarian was advised generally treated seed has a low potential for harm when ingested by livestock. It is quite often the grain or seed itself rather than the treatments that can be problematic. The veterinarian did not further contact the registrant. In this circumstance cottonseed has the potential to impart gossypol toxicity irrespective of any seed treatment. On routine follow up the veterinarian indicated two of the three animals had spontaneously resolved and one remained ataxic. He did not provide further information. At a later date it was discovered the producer/farmer had also contacted the registrant in a different department. He had indicated a bag of the product had been unwittingly dropped in the field while being transported. It was accessible to the animals, but no ingestion was observed. One animal had died but it was dead for several days at the point at which it had been discovered, cause of death is unknown. The owner indicated the dead animal may not have ingested the product. Three animals were observed staggering and brought to the veterinarian. The veterinarian emptied their stomachs and did find cotton seed in the contents. The producer had contacted the registrant the day following their treatment with the veterinarian and he reported they were eating and seemed OK?. No further information is available

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À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Mort

19. Donner des renseignements additionnels ici

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Professionnel de la santé

2.Type d'animal touché

Cow / Vache

3. Race

angus

4. Nombre d'animaux touchés

3

5. Sexe:

Femme

6. Âge (fournir un ordre de grandeur si nécessaire)

Inconnu

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Orale

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

• Systèmes nerveux et musculaire
  • Symptôme - Ataxie

12. Quelle a été la durée des symptômes?

Unknown / Inconnu

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Oui

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Inconnu

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Fully Recovered / Complètement rétabli

16. De quelle manière l'animal a-t-il été exposé?

Accidental ingestion/Ingestion accident.

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-24614220- The reporter, a veterinarian, indicates exposure of four patients to cotton seed treated with the active ingredients abamectin, thiamethoxam, azoxystrobin, fludioxonil and mefenoxam. The caller reports three Angus cattle (Subform III, #2) have presented to him with the primary complaint of ataxia. He indicated the animals had possibly eaten an unknown amount of the product within the past 24-48 hours. He reported that one (or more) animal was dead on the farm (Subform III, #1). It was unknown when or how the animal died. No exposure was observed. On presentation the veterinarian had incomplete product identification information, it was impossible for the registrant to determine the active ingredient or product involved with the information provided. It was recommended the veterinarian obtain a more thorough history and product identification information and contact the registrant back for specific recommendations. The veterinarian was advised generally treated seed has a low potential for harm when ingested by livestock. It is quite often the grain or seed itself rather than the treatments that can be problematic. The veterinarian did not further contact the registrant. In this circumstance cottonseed has the potential to impart gossypol toxicity irrespective of any seed treatment. On routine follow up the veterinarian indicated two of the three animals had spontaneously resolved and one remained ataxic. He did not provide further information. At a later date it was discovered the producer/farmer had also contacted the registrant in a different department. He had indicated a bag of the product had been unwittingly dropped in the field while being transported. It was accessible to the animals, but no ingestion was observed. One animal had died but it was dead for several days at the point at which it had been discovered, cause of death is unknown. The owner indicated the dead animal may not have ingested the product. Three animals were observed staggering and brought to the veterinarian. The veterinarian emptied their stomachs and did find cotton seed in the contents. The producer had contacted the registrant the day following their treatment with the veterinarian and he reported they were eating and seemed OK. No further information is available

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À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Modérée

19. Donner des renseignements additionnels ici