Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2014-4243
2. Registrant Information.
Registrant Reference Number: PROSAR case number: 1-38142925
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.
15-AUG-14
5. Location of incident.
Country: UNITED STATES
Prov / State: MONTANA
6. Date incident was first observed.
15-AUG-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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 100-1431
Product Name: Gramoxone 2.0 SL
- 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: Peas
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
Angus
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
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
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
1-38142925 - The reporter, a veterinarian, indicated that up to 12 or 13 Angus cattle were exposed to an herbicide possibly containing the active ingredient Paraquat. The reporter identified the product by brand name, but clarified that it may be another product containing the same active ingredient or a different product entirely. The reporter stated that his client's neighbor sprayed the product on pea crop 3 days prior to initial contact with the registrant and drift from this treatment contaminated his client's pasture. The cattle were in the pasture during this time. On the day of initial contact, the client discovered that one cow was dead and one cow was sick with unspecified symptoms. The reporter has not responded to follow up calls. 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