Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2397

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-40511046

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.

07-MAY-15

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

06-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. 31408      PMRA Submission No.       EPA Registration No.

Product Name: Vibrance Quattro

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

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Jack Russell Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.375

7. Weight (provide a range if necessary )

6

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
  • Respiratory System
    • Symptom - Wheezing
  • Gastrointestinal System
    • Symptom - Salivating excessively
  • Respiratory System
    • Symptom - Pleural effusion
  • Blood
    • Symptom - Coagulopathy

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

1-40511046 - The reporter, a pet owner, indicated that his dog was exposed to wheat seed coated with a fungicide containing the active ingredients fludioxonil, difenoconazole, metalaxyl-m and sedaxane. The reporter indicated that his 4.5-month-old, 6 pound Jack Russell Terrier ingested seeds treated with this product one day prior to initial contact with the registrant. The reporter believes that the dog ate the seed off of the ground after the reporter emptied it from his hopper. The caller did not witness the exposure but the dog roams freely and the owner noted red dye from the seed on the dogs muzzle. Later that afternoon the dog vomited. On the day of initial contact the reporter indicated that the dog could be heard wheezing and gurgling as he was breathing and he is wet around his muzzle as if he has been drooling. On follow-up call, one day later, the reporter indicated that his dog was currently at the veterinary clinic where they were performing a chest tap to remove pleural effusion. Blood work had showed the dog had a coagulopathy. The reporter indicted that he had initially thought symptoms were secondary to exposure to the Vibrance but now believes the dog got into some of the rodenticide that he keeps on his farm. No additional information is available.


To be determined by Registrant

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

Major

19. Provide supplemental information here

Symptoms not consistent with known safety profile of the product.