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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-5872

2. Registrant Information.

Registrant Reference Number: Prosar 1-16658500

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.

20-SEP-08

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

16-SEP-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: Gramoxone (non-specific)

  • Active Ingredient(s)
    • PARAQUAT
      • Unknown

7. b) Type of formulation.

Liquid

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

Dog / Chien

3. Breed

Labrador Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

65

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Respiratory System
    • Symptom - Respiratory distress
  • Gastrointestinal System
    • Symptom - Mouth Irritation
    • Specify - "Ulcers in mouth and on tongue"
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

2

Day(s) / Jour(s)

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Product had been spilled into a puddle of water that the dog may have drank out of, but actual product exposure was not witnessed.

17. Provide any additional details about the incident

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

1-16658500: A reporter (veterinarian) called on 09/20/2008 to report the possible exposure of a dog to an herbicide containing the active ingredient Paraquat Dichloride. According to the reporter, some cows had knocked over the container of product, spilling some of the concentrated product into a puddle of water (unknown date). The dog┐s exposure to the product was unknown (not witnessed). The dog presented to the veterinarian on 09/16/2008 with oral ulcerations, tongue ulcerations, and respiratory distress. The reporter saw the dog again on 09/17/2008 and 09/20/2008. The reporter took a thoracic radiograph (date unknown) which was clear, and treated the dog with IV fluids. The reporter was advised that ingestion of the product can result in oral ulcerations since the product is corrosive. The reporter was also advised that the product can cause pulmonary fibrosis and kidney damage. A recommendation was made to perform lab work to get baseline kidney values, treat the dog symptomatically and supportively, and to use bronchodilators if needed. It was also recommended to avoid supplemental oxygen. The reporter was faxed an article detailing the monitoring and treatment of animals exposed to Paraquat-based herbicides. An attempt at follow up on 09/22/2008 was unsuccessful. On follow up on 09/23/2008, the reporter stated that the dog had been released from the hospital on 09/22/2008 against medical advice. The dog was still in respiratory distress, but the owner could not afford further hospitalization. The dog died at home on the morning of 09/23/2008. No further information was obtained. NOTE: Actual exposure to the product was not witnessed.


To be determined by Registrant

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

Death

19. Provide supplemental information here

No actual product exposure was witnessed. The clinical signs in this patient could be consistent with product ingestion.