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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3144

2. Registrant Information.

Registrant Reference Number: Prosar 1-19414448

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.

05-AUG-09

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

05-AUG-09

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. 100-799

Product Name: Apron Treated Grass Seed

  • Active Ingredient(s)
    • METALAXYL-M (MEFENOXAM)
      • Unknown

7. b) Type of formulation.

Other (specify)

seed

Application Information

8. Product was applied?

Unknown

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

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Mixed Breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

80

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Gagging
    • Specify - "Trying to vomit but cannot"
    • Symptom - Abdominal distension
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

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

1-19414448: A reporter (dog owner) called on 08/05/2009 to report the exposure of her dog to a grass seed treated with the active ingredient Mefenoxam. According the reporter, the dog ingested the entire contents of a 5-pound bag of product within the hour prior to the report. At the time of the report, the dog's abdomen was distended and he was trying to vomit but was unable to do so. The reporter was advised that the concern is not related to the active ingredient or any toxicity, but to the sheer volume of seed consumed. The reporter was encouraged to take the dog to a veterinarian immediately for evaluation. On follow up, the reporter stated that the dog was not brought to a veterinarian and died on 08/06/2009. A necropsy was performed by the veterinarian and revealed a "flipped" stomach which the veterinarian presumed was the cause of death. No further information was obtained.


To be determined by Registrant

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

Death

19. Provide supplemental information here

The flipped stomach was not caused by Metalaxyl-M but due to volume of grass seed consumed.