Health Canada
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Consumer Product Safety
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-4519
2. Registrant Information.
Registrant Reference Number: 2011-09-19 B
Registrant Name (Full Legal Name no abbreviations): Syngenta Crop Protection Canada, Inc
Address: 140 Research Lane, Research Park
City: Guelph
Prov / State: ON
Country: Canada
Postal Code: N1G 4Z3
3. Select the appropriate subform(s) for the incident.
Scientific Study
4. Date registrant was first informed of the incident.
5. Location of incident.
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.
Active(s)PMRA Registration No. 29642 PMRA Submission No. 2011-4005 EPA Registration No. 100-1347
Product Name: Concert Fungicide
- Active Ingredient(s)
- CHLOROTHALONIL
- PROPICONAZOLE
7. b) Type of formulation.
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 VII: Scientific Study
1. Study Reference
Title Chlorothalonil/Propiconazole SE (A13817D) - Primary Eye Irritation in Rabbits
Date 15-MAR-11
2. a) Is an extension needed to translate the document?
No
3. Type of incident identified in the study
Increased health or environmental risk
4. Describe the incident identified in the study (e.g. study demonstrates an increased risk to non-Hodgkin's Lymphoma after exposure to pesticide X)
Different study endpoint.
5. a) Was the study discontinued before completion?
No
