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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5007

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-24161170

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.

21-SEP-10

5. Location of incident.

Country: UNITED STATES

Prov / State: PENNSYLVANIA

6. Date incident was first observed.

Unknown

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. Unknown

Product Name: Thiamethoxam treated seed corn (unspecified)

  • Active Ingredient(s)
    • THIAMETHOXAM
      • Unknown

7. b) Type of formulation.

Other (specify)

treated seed corn

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

Labrador retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.17

7. Weight (provide a range if necessary )

10

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

  • Gastrointestinal System
    • Symptom - Anorexia
  • Eye
    • Symptom - Other
    • Specify - "sunken eyes"
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Weight loss
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

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

1-24161170- The reporter, a pet owner, indicated his animal had been exposed to seed corn treated with the active ingredient thiamethoxam. The caller indicated his nine week ten pound male Labrador retriever has been chronically ingesting seed corn treated with the active ingredient thiamethoxam over the past few weeks. The reporter indicated the animal had experienced weight loss, loss of appetite, diarrhea and sunken eyes. The caller indicated a veterinarian had been to his farm and placed the animal on what he thinks is an antibiotic but the owner was unsure of the treatment prescribed. At this point in the history collection the pet owner disconnected (his call was lost). Follow-up attempts were made but it was not possible to re-establish a connection with the reporter until the next day. When reconnection was made the owner indicated the animal had died in the night. He indicated the cause was unknown. He did not provide further information. Based on the history provided the product involved is not known (only the active ingredient), it is not known if the exposure was observed, details about the time line remain unknown, and the volume of ingestion remains unknown. Ingestion of thiamethoxam treated seed corn in this species would typically not be expected to yield the outcome seen.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Symptoms are not consistent with exposure to Thiamethoxam.