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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-5873
2. Registrant Information.
Registrant Reference Number: Prosar 1-16766301
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-OCT-085. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
17-OCT-08Product 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. 100-1247
Product Name: Cruiser Maxx Cereals
- Active Ingredient(s)
- FLUDIOXONIL
- METALAXYL
- THIAMETHOXAM
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: winter 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 by a neighbor on the adjacent property on an unknown date. The dog ingested the product on 10/17/2008.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
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Unknown breed
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
50
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 - Vomiting
12. How long did the symptoms last?
>3 days <=1 wk / >3 jours <=1 sem
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
No
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Fully Recovered / Complètement rétabli
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
1-16766301: A reporter called on 10/20/2008 to report the exposure of a dog to insecticide/fungicide coated seed containing the active ingredients Fludioxonil, Thiamethoxam, and Metalaxyl. According to the reporter, the product was applied by a neighbor to the adjacent property on an unknown date. The product spilled onto the reporter's property and the dog ingested an unknown amount on 10/17/2008. The dog started vomiting on 10/17/2008 (unknown how long after product ingestion) and was still vomiting at the time of the report. The reporter had the Material Data Safety Sheet (MSDS) and was planning to take the dog to the veterinarian. The reporter was advised that ingestion of the product can result in GI upset. Massive ingestions may result in liver toxicity. A recommendation was made to have the dog evaluated by a veterinarian given the persistence of signs. On follow up, the reporter stated that he had provided the MSDS to the veterinarian on 10/20/2008. The veterinarian recommended monitoring the signs (it is unclear whether the dog was evaluated by the veterinarian or whether a phone consult was done). The dog was significantly improved on 10/21/2008 and had not vomited in two days at the time of follow up. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
