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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3567

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-34063042

Registrant Name (Full Legal Name no abbreviations): Syngenta 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-JUN-13

5. Location of incident.

Country: UNITED STATES

Prov / State: NEBRASKA

6. Date incident was first observed.

20-JUN-13

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 (nonspecific)

  • Active Ingredient(s)
    • FLUAZIFOP-P-BUTYL
      • Unknown

PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: Round Up (unspecific)

  • Active Ingredient(s)
    • GLYPHOSATE

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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Soybean

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

Medical Professional

2. Type of animal affected

Cow / Vache

3. Breed

Cross bred

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.5

7. Weight (provide a range if necessary )

450

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

  • 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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-34063042- The reporter, a veterinarian, indicated an animal may have been exposed to a product containing the herbicide Fluazifop-P-Butyl. The reporter indicated his client, the animal owner, had called the veterinarian the same morning of the initial report to indicate a six month four hundred fifty pound mixed breed steer had escaped its pasture some time the day prior to the initial report. The animal had entered an application area where the product and a non-registrant product had been applied within two days of the exposure. The animal may have consumed soybeans that had been treated. No discreet exposure incident was described. The animal had been found dead the morning of the initial report. The reporter had not examined the animal or the animals remains. The reporter was only able to provide product identification by incomplete name. With the information provided by the reporter it was possible to identify active ingredient of the registrants product but not specific formulation. The non-registrant product was identified by the name Round up. It is probable this second product is a glyphosate based product but the formulation is unknown. The caller was advised the observed outcome would not be consistent with the profile of the active ingredient Fluazifop-P-Butyl. He was encouraged to obtain a necropsy and provide results as they became available. He was also encouraged to contact the registrant of the Round Up product directly to discuss expectations of that product. No further information is available.


To be determined by Registrant

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

Death

19. Provide supplemental information here