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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-4916

2. Registrant Information.

Registrant Reference Number: 1-34808952

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.


5. Location of incident.

Country: CANADA


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. 26396      PMRA Submission No.       EPA Registration No.

Product Name: Reglone Liquid Herbicide and Desiccant

  • Active Ingredient(s)
    • DIQUAT

7. b) Type of formulation.

Application Information

8. Product was applied?


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?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Rough Collie

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

Unknown / Inconnu

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Mouth Irritation
    • Specify - Oral and esophageal ulcers
    • Symptom - Anorexia
    • Symptom - Abnormal tongue colour
    • Symptom - Foaming at mouth
    • Symptom - Oral hemorrhage
  • Skin
    • Symptom - Discolouration
    • Specify - fur changed color
  • Gastrointestinal System
    • Symptom - Abnormal tongue colour
    • Specify - tongue discoloration
    • Symptom - Other
    • Specify - blood in mouth
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Other
    • Specify - sore mouth

12. How long did the symptoms last?

Unknown / Inconnu

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?

Other / Autre

specify accidental dermal exposure to run off from the sprayer

17. Provide any additional details about the incident

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

1-34808952 - The reporter, a pet owner, indicated that his dog was exposed to an herbicide containing the active ingredient diquat. The reporter indicated that his 10-month-old, male, 57 pound Rough Collie was lying and rolling in the run off from the sprayer one day prior to initial contact with the registrant. The dog was bathed after the exposure but at the time of initial contact the reporter indicated that the dogs fur had changed color from white to orange, the tongue was grey, the dog was frothing at the mouth, and had some blood in its mouth and was not eating or drinking. The reporter was advised that prolonged skin contact to the wet product and potential ingestion of the product is a serious concern and the dog should be evaluated by a veterinarian. On follow-up call, one day later, the reporter indicated that the veterinarian collected blood but blood work results were pending. The veterinarian identified ulcers in the dogs mouth and indicated that the esophagus also likely had ulcers. The dog was sent home on sucralfate, pepcid and tramadol. Per the reporter the dog is still lethargic and the mouth was still sore but the bleeding in the mouth had stopped and the dog was eating soft food. Further follow up with the reporter indicated that the dog had recovered and is doing fine. 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