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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2880

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-26561558

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.


5. Location of incident.


Prov / State: WASHINGTON

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1217

Product Name: Gramoxone Inteon

  • Active Ingredient(s)
      • Guarantee/concentration 30.1 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Industrial / Industriel

Préciser le type: unknown/weeds

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?


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


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms


  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Unresponsive
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


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

1-26561558- The reporter indicates his employer¿s dog may have been exposed to an herbicide containing the active ingredient paraquat. The reporter indicates a pest control operator had applied the product to weeds adjacent to his workplace two days prior to his initial contact with the registrant. The reporter indicated his employers eighteen pound male mixed breed dog had access to the application site and the truck in which the product was carried. No exposure was observed but the caller indicates they have noted a change in the dog¿s outward affect the day of his call. The caller reports the dog is normally active and energetic but at the point of his initial call the animal was reported to be weak and lying around. The caller was concerned the dog may have ingested some of the product that had leaked out of a container in the truck. The caller was advised to seek immediate veterinary care. He was advised of treatment protocols and prognosis following ingestion exposures of the active ingredient in domestic animals. The caller had not initially responded to follow up attempts until yet another employee of the animal owner called back ten days later and indicated the animal was brought to the veterinarian 3-4 days after the potential exposure. The caller reported the animal had died in the veterinarian¿s care. The veterinarian had given the animal 'pain pills' and oxygen. The animal had apparently gotten worse and died. The caller was unable to provide further information regarding either the exposure or the care/diagnostics provided the animal. No further information is available.

To be determined by Registrant

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


19. Provide supplemental information here

Symptoms are not consistent with exposure to paraquat. No discrete exposure incident was observed or recorded.