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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-2251

2. Registrant Information.

Registrant Reference Number: PROSAR case number: 1-37415705

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.

09-JUN-14

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

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.       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: 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

Dog / Chien

3. Breed

Australian Shepherd

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

80

lbs

8. Route(s) of exposure

Skin

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 - Death
  • Respiratory System
    • Symptom - Heavy breathing
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Drooling
  • Blood
    • Symptom - Other
    • Specify - Splenomegaly

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-37415705 - The reporter, a pet owner, indicated that his dog was exposed to an herbicide containing the active ingredient Paraquat. The reporter stated that he applied the diluted product to his field either 3 or 4 days prior to initial contact with the registrant. During product application the reporters 7-year-old, 80 pound, female Australian Shepherd was in the field. The dog was not bathed after the exposure and may have ingested the product while grooming. At the time of the initial call the reporter indicated that his dog was lethargic, drooling and breathing hard. The dog was brought to the veterinarian one day prior to initial contact with the registrant where blood work was found to be normal and x-rays showed a possible enlarged spleen. On follow-up call, two days later, the reporter indicated that the dog had died at home that morning. The reporter had been taking the dog to the veterinarian every day since his initial call. The treatment provided and diagnosis was not indicated by the reporter. 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