Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-4234

2. Registrant Information.

Registrant Reference Number: PROSAR case number: 1-37795180

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-JUL-14

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

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. Unknown

Product Name: Dynasty PD treated peanut seeds

• Active Ingredient(s)
  • AZOXYSTROBIN
    • Guarantee/concentration 3.2 %
  • FLUDIOXONIL
    • Guarantee/concentration 2 %
  • METALAXYL-M (MEFENOXAM)
    • Guarantee/concentration .4 %

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7. b) Type of formulation.

Other (specify)

Seed treatment

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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

Cow / Vache

3. Breed

Beef cow

4. Number of animals affected

2

5. Sex

Unknown

6. Age (provide a range if necessary )

1

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

• 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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-37795180 - The reporter, a veterinarian, indicated that 4 yearling beef calves were exposed to peanuts treated with a fungicide containing the active ingredients azoxystrobin, mefenoxam and fludioxonil. The reporter stated that the calves got into the product sometime within 48 hours of her initial call. At the time of her initial call two calves were found dead and two other calves were down and unable to rise. The reporter was advised that the amount of fungicide on the peanuts is very minimal and would not be expected to cause the described symptoms. A necropsy was recommended to help determine the cause of death. The reporter could not be reached on follow-up. 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