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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-5813
2. Registrant Information.
Registrant Reference Number: PROSAR CB#1-23866633
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-AUG-105. Location of incident.
Country: UNITED STATES
Prov / State: NORTH CAROLINA
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: Fusilade (non-specific)
- Active Ingredient(s)
- FLUAZIFOP-P-BUTYL
- Unknown
- FLUAZIFOP-P-BUTYL
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
Site: Pub. Area - Outdoor/Zone publique - ext
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
Shih Tzu
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
7
7. Weight (provide a range if necessary )
Unknown
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 - Vomiting
- Symptom - Diarrhea
- General
- Symptom - Lethargy
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.
Yes
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Fully Recovered / Complètement rétabli
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
1-23866633- The reporter, a pet owner, calls to indicate possible exposure of her animal and her neighbors animals to an herbicide containing the active ingredient Fluazifop-P-Butyl. The caller did not indicate how the product was applied, when the produ
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
No evidence of exposure. The only doc that may have been exposed recovered fully.
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
Shih Tzu
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
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 - Diarrhea
- Symptom - Vomiting
- General
- Symptom - Lethargy
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.
Yes
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Fully Recovered / Complètement rétabli
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
1-23866633- The reporter, a pet owner, calls to indicate possible exposure of her animal and her neighbors animals to an herbicide containing the active ingredient Fluazifop-P-Butyl. The caller did not indicate how the product was applied, when the product was applied, or if the proper re-entry interval was observed. The caller indicates her dog, a seven year female Shih Tzu (Sub form III, #1) may have had access to an application area at some indeterminate time or for some indeterminate duration. The caller indicates her animal may have walked through the public application area and groomed her feet (licked) though no discreet exposure incident was described. The reporter indicates her animal developed vomiting, diarrhea and lethargy four days prior to the initial contact with the registrant and was brought to the veterinarian. The caller did not indicate the temporal relationship between the onset of signs and the exposure. The animal was given antemetic medication and an oral antibiotic by the veterinarian and had resolved at the point of the initial contact with the registrant. The caller also indicated a neighbors female ShihTzu (Sub-form III #2) weeks before her initial contact with the registrant developed signs of vomiting, lethargy, and diarrhea. The caller did not describe any exposure but indicated the dog frequented the area her dog frequents. The neighbors animal had, as well, been to the veterinarian and given medication (unspecified) resolving its signs. The caller also indicated yet anther neighbor had two West Highland White Terriers that had died at some unspecified point. She did not indicate an exposure merely that the animals shared the same community. The caller states one animal died after succumbing to cancer (Sub form III #3) but did not provide any more detail, and the final animal (Sub form III, #4)died after some unspecified gastrointestinal disorder. She did not provide any more detail about this animal either. The caller was advised the signs and outcome described would not be consistent with use of this product according to the label. She was advised to consult her veterinarian to explore the illnesses described further.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
West Highland White Terrier
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
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
- General
- Symptom - Cancer
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?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-23866633- The reporter, a pet owner, calls to indicate possible exposure of her animal and her neighbors¿ animals to an herbicide containing the active ingredient Fluazifop-P-Butyl. The caller did not indicate how the product was applied, when the product was applied, or if the proper re-entry interval was observed. The caller indicates her dog, a seven year female Shih Tzu (Sub form III, #1) may have had access to an application area at some indeterminate time or for some indeterminate duration. The caller indicates her animal may have walked through the public application area and groomed her feet (licked) though no discreet exposure incident was described. The reporter indicates her animal developed vomiting, diarrhea and lethargy four days prior to the initial contact with the registrant and was brought to the veterinarian. The caller did not indicate the temporal relationship between the onset of signs and the exposure. The animal was given antemetic medication and an oral antibiotic by the veterinarian and had resolved at the point of the initial contact with the registrant. The caller also indicated a neighbor¿s female ShihTzu (Sub-form III #2) weeks before her initial contact with the registrant developed signs of vomiting, lethargy, and diarrhea. The caller did not describe any exposure but indicated the dog frequented the area her dog frequents. The neighbor¿s animal had, as well, been to the veterinarian and given medication (unspecified) resolving its signs. The caller also indicated yet anther neighbor had two West Highland White Terriers that had died at some unspecified point. She did not indicate an exposure merely that the animals shared the same community. The caller states one animal died after succumbing to cancer (Sub form III #3) but did not provide any more detail, and the final animal (Sub form III, #4)died after some unspecified gastrointestinal disorder. She did not provide any more detail about this animal either. The caller was advised the signs and outcome described would not be consistent with use of this product according to the label. She was advised to consult her veterinarian to explore the illnesses described further.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
West Highland White Terrier
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
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 - Other
- Specify - Gastrointestinal symptoms unspecified
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?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-23866633- The reporter, a pet owner, calls to indicate possible exposure of her animal and her neighbors¿ animals to an herbicide containing the active ingredient Fluazifop-P-Butyl. The caller did not indicate how the product was applied, when the product was applied, or if the proper re-entry interval was observed. The caller indicates her dog, a seven year female Shih Tzu (Sub form III, #1) may have had access to an application area at some indeterminate time or for some indeterminate duration. The caller indicates her animal may have walked through the public application area and groomed her feet (licked) though no discreet exposure incident was described. The reporter indicates her animal developed vomiting, diarrhea and lethargy four days prior to the initial contact with the registrant and was brought to the veterinarian. The caller did not indicate the temporal relationship between the onset of signs and the exposure. The animal was given antemetic medication and an oral antibiotic by the veterinarian and had resolved at the point of the initial contact with the registrant. The caller also indicated a neighbor¿s female ShihTzu (Sub-form III #2) weeks before her initial contact with the registrant developed signs of vomiting, lethargy, and diarrhea. The caller did not describe any exposure but indicated the dog frequented the area her dog frequents. The neighbor¿s animal had, as well, been to the veterinarian and given medication (unspecified) resolving its signs. The caller also indicated yet anther neighbor had two West Highland White Terriers that had died at some unspecified point. She did not indicate an exposure merely that the animals shared the same community. The caller states one animal died after succumbing to cancer (Sub form III #3) but did not provide any more detail, and the final animal (Sub form III, #4)died after some unspecified gastrointestinal disorder. She did not provide any more detail about this animal either. The caller was advised the signs and outcome described would not be consistent with use of this product according to the label. She was advised to consult her veterinarian to explore the illnesses described further.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
