Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-7065

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-35564062

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-NOV-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

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. 30864      PMRA Submission No.       EPA Registration No.

Product Name: Lumex EZ

• Active Ingredient(s)
  • ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
  • MESOTRIONE
  • S-METOLACHLOR AND R-ENANTIOMER

---

7. b) Type of formulation.

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: Unknown

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

Cat / Chat

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

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

• Eye
  • Symptom - Discharge eye

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Anorexia

• Respiratory System
  • Symptom - Respiratory congestion

12. How long did the symptoms last?

Unknown / Inconnu

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

Yes

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

specify Exposure was not witnessed but caller was concerned that the cats may have had access to the treated area.

17. Provide any additional details about the incident

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

1-35564062 - The reporter, a veterinarian, indicated that three cats may have been exposed to an herbicide containing the active ingredients s-metolachlor, atrazine and Mesotrione. The reporter indicated that two of her mother-in-laws cats (Subform III #1 and #2) had become ill with ocular discharge, nasal congestion, lethargy and inappetance approximately two to four days prior to initial contact with the registrant. The reporter had treated one of these cats (Subform III #1) with an injection of Convenia and subcutaneous fluids. At the time of the initial call the other cat (Subform III #2) was missing but once found the reporter intended to provide the same treatment. The reporter also stated that there was a third cat (Subform III #3) that seemed to be a little ill. Although exposure to the application site was not witnessed, the reporter indicated that the cats all had free access to the outdoors and while walking around the pet owner's home the reporter noted a sign stating the area was an experimental testing site for Syngenta products. The reporter was calling to determine which products were applied to the site to determine if exposure to the application site might be the cause for the illness of the cats. The active ingredients that had been used at the testing site were provided and the reporter was advised that the described symptoms may be consistent with an upper respiratory infection secondary to a herpes virus or calici virus infection. No further information is available.

---

To be determined by Registrant

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

Minor

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

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

• Eye
  • Symptom - Discharge eye

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Lethargy

• Respiratory System
  • Symptom - Respiratory congestion

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

specify Although no exposure was witnessed the caller was concerned that the cat may have had access to the application site.

17. Provide any additional details about the incident

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

1-35564062 - The reporter, a veterinarian, indicated that three cats may have been exposed to an herbicide containing the active ingredients s-metolachlor, atrazine and Mesotrione. The reporter indicated that two of her mother-in-laws cats (Subform III #1 and #2) had become ill with ocular discharge, nasal congestion, lethargy and inappetance approximately two to four days prior to initial contact with the registrant. The reporter had treated one of these cats (Subform III #1) with an injection of Convenia and subcutaneous fluids. At the time of the initial call the other cat (Subform III #2) was missing but once found the reporter intended to provide the same treatment. The reporter also stated that there was a third cat (Subform III #3) that seemed to be a little ill. Although exposure to the application site was not witnessed, the reporter indicated that the cats all had free access to the outdoors and while walking around the pet owner's home the reporter noted a sign stating the area was an experimental testing site for Syngenta products. The reporter was calling to determine which products were applied to the site to determine if exposure to the application site might be the cause for the illness of the cats. The active ingredients that had been used at the testing site were provided and the reporter was advised that the described symptoms may be consistent with an upper respiratory infection secondary to a herpes virus or calici virus infection. No further information is available.

---

To be determined by Registrant

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

Minor

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

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 - Malaise

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

specify Although no exposure was witnessed the caller was concerned that the cat may have had access to the application site.

17. Provide any additional details about the incident

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

1-35564062 - The reporter, a veterinarian, indicated that three cats may have been exposed to an herbicide containing the active ingredients s-metolachlor, atrazine and Mesotrione. The reporter indicated that two of her mother-in-laws cats (Subform III #1 and #2) had become ill with ocular discharge, nasal congestion, lethargy and inappetance approximately two to four days prior to initial contact with the registrant. The reporter had treated one of these cats (Subform III #1) with an injection of Convenia and subcutaneous fluids. At the time of the initial call the other cat (Subform III #2) was missing but once found the reporter intended to provide the same treatment. The reporter also stated that there was a third cat (Subform III #3) that seemed to be a little ill. Although exposure to the application site was not witnessed, the reporter indicated that the cats all had free access to the outdoors and while walking around the pet owner's home the reporter noted a sign stating the area was an experimental testing site for Syngenta products. The reporter was calling to determine which products were applied to the site to determine if exposure to the application site might be the cause for the illness of the cats. The active ingredients that had been used at the testing site were provided and the reporter was advised that the described symptoms may be consistent with an upper respiratory infection secondary to a herpes virus or calici virus infection. No further information is available.

---

To be determined by Registrant

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

Minor

19. Provide supplemental information here