Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-3157

2. Registrant Information.

Registrant Reference Number: PROSAR case number: 1-37758534

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.

10-JUL-14

5. Location of incident.

Country: UNITED STATES

Prov / State: ILLINOIS

6. Date incident was first observed.

26-JUN-14

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. 100-1070

Product Name: Fusilade Dx

• Active Ingredient(s)
  • FLUAZIFOP-P-BUTYL
    • Guarantee/concentration 24.5 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1169

Product Name: Touchdown Total

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS POTASSIUM SALT)
    • Guarantee/concentration 44.9 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: Unknown

• Active Ingredient(s)
  • AMMONIUM SULPHATE

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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: Soybeans

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

Other

2. Type of animal affected

Other / Autre

specify Goat

3. Breed

Unknown

4. Number of animals affected

14

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

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

• Blood
  • Symptom - Other
  • Specify - Blood does not clot on postmortem and seems runny

• Skin
  • Symptom - Pale mucous membrane colour
  • Specify - Pale organs and mucus membranes

• Gastrointestinal System
  • Symptom - Other
  • Specify - Gastroduodenal Ulcer
  • Symptom - Melena

• General
  • Symptom - Death
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Ataxia
  • Symptom - Muscle weakness

• Gastrointestinal System
  • Symptom - Other
  • Specify - Inflammed abomasum

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

1-37758534 - The reporter, a farmer, indicated that some goats from a neighboring farm were exposed to two different registrant herbicides containing the active ingredients Fluazifop-p-butyl and Glyphosphate and to a non-registrant product containing the active ingredient ammonium sulfate. The reporter indicated that these products were applied by plane fifteen days prior to initial contact with the registrant. During application there was some drift to a neighboring farm and the reporter just recently learned that goats on the neighboring farm had been dying. On the day of initial contact the treating veterinarian also called. Per the treating veterinarian 14 young goats, approximately 60-70 pounds of different unidentified breeds had died. The first death was noted about 2 days after application of the herbicides. The reporter indicated that the rate of death had decreased but on the day of his call he had been informed of two more deaths. Per the veterinarian, the farmer also had sheep but the sheep were not affected. The veterinarian indicated that the goats were reaching their heads over the fence and ingesting plants from the drift site but the sheep were not doing this. The veterinarian indicated that symptoms seen prior to death included lethargy and wobbliness; as if the animals were weak and could not hold their heads up. The veterinarian did a necropsy on one of the dead goats and found pale organs and mucous membranes, a duodenal ulcer, gastric hemorrhage, an inflamed abomasum and black tarry stool. The reporter also indicated that the blood on the dead animal was really watery and did not clot. He did not perform a clotting time on any of the goats. The reporter was advised that ingestion of the product may result in transient gastrointestinal irritation but the described symptoms are not consistent with exposure to the applied product. 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