Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-6123

2. Registrant Information.

Registrant Reference Number: 1-35255092

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.

16-OCT-13

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

16-OCT-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1399

Product Name: Avicta Complete Corn 500

• Active Ingredient(s)
  • ABAMECTIN
    • Guarantee/concentration 10.2 %
  • AZOXYSTROBIN
    • Guarantee/concentration .12 %
  • FLUDIOXONIL
    • Guarantee/concentration .3 %
  • METALAXYL-M (MEFENOXAM)
    • Guarantee/concentration .23 %
  • THIABENDAZOLE
    • Guarantee/concentration 2.31 %
  • THIAMETHOXAM
    • Guarantee/concentration 23.1 %

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7. b) Type of formulation.

Other (specify)

Corn seed coating

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Other / Autre

Préciser le type: seed

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

Unknown

4. Number of animals affected

2

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

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 - Lethargy
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Yes

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-35255092 - The reporter, a veterinarian, indicated that eight cows were exposed to corn seeds which had been treated with the active ingredients Thiabendazole, thiamethoxam, fludioxonil, metalaxyl-m, abamectin, and Azoxystrobin. The reporter indicated that on the day of initial contact with the registrant about 8 cows got into the barn and ingested approximately 40-50 pounds of treated corn. At the time of the initial call the veterinarian had not yet seen the cows but was told that 2 cows were lethargic. On follow-up call, one day later, the reporter indicated that he treated the 2 cows that were exhibiting symptoms for grain overload but they both died later that night. The reporter believed the death of the two cows was secondary to grain overload and not related to the active ingredients on the treated corn. No further information is available.

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To be determined by Registrant

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

Death

19. Provide supplemental information here