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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2845

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16328765

Registrant Name (Full Legal Name no abbreviations): Syngenta Crop Protection 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.

26-JUN-08

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

25-JUN-08

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.

Product Name: Axial Herbicide (non-specific)

  • Active Ingredient(s)
    • PINOXADEN

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Wheat

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

The product was applied to a wheat field about 1 week prior to the call. It had rained since the application of the product.

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

Dog / Chien

3. Breed

Jack Russell Terrier

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

14

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

  • Gastrointestinal System
    • Symptom - Bloody vomit
  • Respiratory System
    • Symptom - Nasal congestion
    • Symptom - Coughing

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-16328765: The reporter, a veterinary clinic employee, called on 6/26 to report the possible exposure of a dog to a product containing the active ingredient Pinoxaden. According to the reporter, a 7 year old female dog had been playing in a wheat field on 6/25 and had ingested some wheat. The wheat had been sprayed about one week previously with an un-specified Axial brand herbicide, and it had rained at some point after the product had been applied. Per the reporter, the dog had produced some bloody vomit the evening of 6/25 and now could not eat without vomiting. The reporter inquired about and was given information related to the safety profile of the product. This included the fact that the time lag between application of the product and the actual exposure would make it unlikely that the dog¿s symptoms were representative of the described event. A follow-up call on 6/30 revealed the dog was a bit congested, but her energy level was fine. A cough which had been previously unreported had resolved.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Moderate

19. Provide supplemental information here

The above incident is highly unlikely to have been caused by Axial. The symptoms described above are not typical of exposure to this product. The label has a seven day grazing statement.