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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2361

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-40595976

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-MAY-15

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

14-MAY-15

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. 28821      PMRA Submission No.       EPA Registration No.

Product Name: Cruiser Maxx Beans Seed Treatment

  • Active Ingredient(s)
    • FLUDIOXONIL
    • METALAXYL-M (MEFENOXAM)
    • THIAMETHOXAM

PMRA Registration No. 30438      PMRA Submission No.       EPA Registration No.

Product Name: Vibrance 500FS Seed Treatment

  • Active Ingredient(s)
    • SEDAXANE

7. b) Type of formulation.

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

Dog / Chien

3. Breed

Mixed breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

62

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
  • Nervous and Muscular Systems
    • Symptom - Shaking
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Loss of appetite

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

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

1-40595976 - The reporter, a veterinarian, indicated that a dog was exposed to soybeans treated with a fungicide and an insecticide containing the active ingredients sedaxane, metalaxyl-m, fludioxonil and thiamethoxam. The reporter stated that the 62 pound, male mixed breed dog ingested a handful of the soybeans one day prior to initial contact with the registrant. Soon after the ingestion the dog vomited and was shivering. On the day of initial contact the dog presented to the clinic lethargic with a decreased appetite. The reporter was advised that the product has a wide margin of safety but with ingestion transient gastrointestinal irritation is possible. The reporter indicated that the dog had also recently eaten a sock, bones and a plastic container. It was recommended that the reporter rule out a possible gastrointestinal foreign body as a cause for the dogżżżżżżs symptoms. No additional information is available.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Minor

19. Provide supplemental information here