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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-0228

2. Registrant Information.

Registrant Reference Number: 1-35237374

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.

14-OCT-13

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

14-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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1217

Product Name: Gramoxone Inteon

  • Active Ingredient(s)
    • PARAQUAT
      • Guarantee/concentration 30.1 %

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: Cotton

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

Dog / Chien

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

  • Gastrointestinal System
    • Symptom - Diarrhea
  • General
    • Symptom - Death
  • Gastrointestinal System
    • Symptom - Foaming at mouth

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

1-35237374 - The reporter, a veterinarian, indicated that two dogs were exposed to an herbicide containing the active ingredient Paraquat. The reporter stated that the product was applied to a nearby cotton field. The reporter and the pet owner were not sure exactly what day the product was applied. The reporter indicated that both of the pet owners dogs were free roaming in the field on the day of initial contact with the registrant. They are not sure if the product was wet when the dogs entered the field. Later in the day they found one of the dogs dead. The corpse showed evidence of diarrhea and foaming at the mouth. The other dog was at the time of the initial call at the veterinary clinic tremoring, hypersalivating, vomiting and was later thought to be tachypneic. The reporter was advised that there are numerous possible causes for the described symptoms and diagnostics tests were recommended to determine an underlying cause and appropriate treatment. The reporter could not be reached for follow-up. 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