Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2014-0232

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: PROSAR case: 1-35807725

Nom du titulaire (nom légal complet, aucune abbréviation): Syngenta 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.

21-DEC-13

5. Lieu de l'incident.

Pays: CANADA

État: ONTARIO

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 28821      ARLA No de la demande d'homologation       EPA No d'homologation.

Nom du produit: Cruiser Maxx Beans Seed Treatment

• Matière active
  • FLUDIOXONIL
  • METALAXYL-M (MEFENOXAM)
  • THIAMETHOXAM

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7. b) Type de formulation.

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

Professionnel de la santé

2.Type d'animal touché

Cat / Chat

3. Race

Unknown

4. Nombre d'animaux touchés

1

5. Sexe:

Inconnu

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

0.75

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

• Système gastro-intestinal
  • Symptôme - Anorexie
  • Symptôme - Vomit

• General
  • Symptôme - Lethargie
  • 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.

Oui

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

Oui

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

1

Day(s) / Jour(s)

15. Issue de l'incident

Mort

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

Other / Autre

préciser Exposure was not witnessed but caller was concerned that the cats may have had access to the seed.

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

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

1-35807725 - The reporter, a veterinarian, indicated that four cats may have been exposed to bean seeds which had been treated with the active ingredients thiamethoxam, fludioxonil and metalaxyl-m. On the day of initial contact with the registrant four 9-month old cats were brought to her clinic for care. Although no exposure to this product was witnessed the reporter stated that the cats went into the barn where there was a bag of treated bean seeds that the cats could have gotten into. Per the reporter the two male cats (Subform III #2) had been anorexic and vomiting for the past 2 days and at the time of presentation were dehydrated. The reporter ran a small blood work panel on these two cats which showed increased BUN. The pet owner elected to euthanize these two cats. A third cat (Subform III #3) had vomited just once that day, its blood work was normal and it did not require any treatment. A fourth cat (Subform III #1) vomited a large amount of yellow fluid that day, it was anorexic and lethargic. Blood work was not run on this cat. This cat was hospitalized on intravenous fluids and at the time of the initial call the reporter indicated that the cat was not improving as expected. On follow-up call, two days later, a veterinary staff member indicated that the hospitalized cat (Subform III #1) died while still at the veterinary clinic, one day after initial contact. The reporter was advised that there is a very small amount of active ingredient on the treated bean seeds and death is not consistent with exposure to the product. The reporter was further advised that there are numerous possible causes for vomiting and anorexia including infectious agents. A necropsy was recommended to determine an underlying cause for the described symptoms. 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

Cat / Chat

3. Race

Unknown

4. Nombre d'animaux touchés

2

5. Sexe:

Homme

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

0.75

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

• Système gastro-intestinal
  • Symptôme - Anorexie
  • Symptôme - Vomit

• General
  • Symptôme - Déshydratation

• Sang
  • Symptôme - Azote uréique du sang augmenté
  • Specify - Increased Bun

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.

Oui

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

Euthanised / Euthanasie

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

Other / Autre

préciser Although no exposure was witnessed the caller was concerned that the cat may have had access to the bag of treated bean seeds.

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

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

1-35807725 - The reporter, a veterinarian, indicated that four cats may have been exposed to bean seeds which had been treated with the active ingredients thiamethoxam, fludioxonil and metalaxyl-m. On the day of initial contact with the registrant four 9-month old cats were brought to her clinic for care. Although no exposure to this product was witnessed the reporter stated that the cats went into the barn where there was a bag of treated bean seeds that the cats could have gotten into. Per the reporter the two male cats (Subform III #2) had been anorexic and vomiting for the past 2 days and at the time of presentation were dehydrated. The reporter ran a small blood work panel on these two cats which showed increased BUN. The pet owner elected to euthanize these two cats. A third cat (Subform III #3) had vomited just once that day, its blood work was normal and it did not require any treatment. A fourth cat (Subform III #1) vomited a large amount of yellow fluid that day, it was anorexic and lethargic. Blood work was not run on this cat. This cat was hospitalized on intravenous fluids and at the time of the initial call the reporter indicated that the cat was not improving as expected. On follow-up call, two days later, a veterinary staff member indicated that the hospitalized cat (Subform III #1) died while still at the veterinary clinic, one day after initial contact. The reporter was advised that there is a very small amount of active ingredient on the treated bean seeds and death is not consistent with exposure to the product. The reporter was further advised that there are numerous possible causes for vomiting and anorexia including infectious agents. A necropsy was recommended to determine an underlying cause for the described symptoms. 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

Cat / Chat

3. Race

Unknown

4. Nombre d'animaux touchés

1

5. Sexe:

Inconnu

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

0.75

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

• Système gastro-intestinal
  • Symptôme - Vomit

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?

Non

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?

Other / Autre

préciser Although no exposure was witnessed the caller was concerned that the cat may have had access to the bag of treated bean seeds.

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

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

1-35807725 - The reporter, a veterinarian, indicated that four cats may have been exposed to bean seeds which had been treated with the active ingredients thiamethoxam, fludioxonil and metalaxyl-m. On the day of initial contact with the registrant four 9-month old cats were brought to her clinic for care. Although no exposure to this product was witnessed the reporter stated that the cats went into the barn where there was a bag of treated bean seeds that the cats could have gotten into. Per the reporter the two male cats (Subform III #2) had been anorexic and vomiting for the past 2 days and at the time of presentation were dehydrated. The reporter ran a small blood work panel on these two cats which showed increased BUN. The pet owner elected to euthanize these two cats. A third cat (Subform III #3) had vomited just once that day, its blood work was normal and it did not require any treatment. A fourth cat (Subform III #1) vomited a large amount of yellow fluid that day, it was anorexic and lethargic. Blood work was not run on this cat. This cat was hospitalized on intravenous fluids and at the time of the initial call the reporter indicated that the cat was not improving as expected. On follow-up call, two days later, a veterinary staff member indicated that the hospitalized cat (Subform III #1) died while still at the veterinary clinic, one day after initial contact. The reporter was advised that there is a very small amount of active ingredient on the treated bean seeds and death is not consistent with exposure to the product. The reporter was further advised that there are numerous possible causes for vomiting and anorexia including infectious agents. A necropsy was recommended to determine an underlying cause for the described symptoms. No further information is available.

---

À être déterminé par le titulaire

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

Mineure

19. Donner des renseignements additionnels ici