Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-2250

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-37242345

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.

28-MAY-14

5. Location of incident.

Country: UNITED STATES

Prov / State: MARYLAND

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1414

Product Name: Lexar EX Herbicide

• Active Ingredient(s)
  • ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
    • Guarantee/concentration 18.6 %
  • MESOTRIONE
    • Guarantee/concentration 2.44 %
  • S-METOLACHLOR AND R-ENANTIOMER
    • Guarantee/concentration 19 %

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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: 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

Animal's Owner

2. Type of animal affected

Bird - Poultry / Oiseau - Volaille

3. Breed

Rhode Island Hen

4. Number of animals affected

1

5. Sex

Female

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

>8 hrs <=24 hrs / > 8 h < = 24 h

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

1-37242345 - The reporter, a pet owner indicated that her chickens were exposed to an herbicide containing the active ingredients s-metolachlor, atrazine and mesotrione. The reporter indicated that two days prior to initial contact with the registrant the neighbor farmer was spraying this product along her fence line. The reporter was outdoors and ended up getting drenched with the product. No direct exposure to her chickens was noted but two days later the reporter found her Barred Rock Rooster (Subform III #2) and her Rhode Island Hen (Subform III #1) dead. The reporter states that both of the dead chickens had purple faces but the cause for death was not evident. The reporter also states that she has fish, ducks and horses and they did not have any symptoms. Her dog had some ocular discharge at the time of the initial call but was otherwise fine. 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

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Bird - Poultry / Oiseau - Volaille

3. Breed

Barred Rock Rooster

4. Number of animals affected

1

5. Sex

Male

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

>8 hrs <=24 hrs / > 8 h < = 24 h

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?

Spray drift / Dérive de pulvérisation

17. Provide any additional details about the incident

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

1-37242345 - The reporter, a pet owner indicated that her chickens were exposed to an herbicide containing the active ingredients s-metolachlor, atrazine and mesotrione. The reporter indicated that two days prior to initial contact with the registrant the neighbor farmer was spraying this product along her fence line. The reporter was outdoors and ended up getting drenched with the product. No direct exposure to her chickens was noted but two days later the reporter found her Barred Rock Rooster (Subform III #2) and her Rhode Island Hen (Subform III #1) dead. The reporter states that both of the dead chickens had purple faces but the cause for death was not evident. The reporter also states that she has fish, ducks and horses and they did not have any symptoms. Her dog had some ocular discharge at the time of the initial call but was otherwise fine. 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