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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-1167

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-43089122

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.


5. Location of incident.


Prov / State: CALIFORNIA

6. Date incident was first observed.


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.


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

Product Name: Gramoxone

  • Active Ingredient(s)
      • Unknown

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


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

Site: Res. - Out Home / Rés - à l'

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

1-43089122 - The reporter's father applied the product on the lawn. It is unknown if the product was diluted before it was applied. The reporter's three dogs went out on the lawn while the product was still wet.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Miniature Pinscher

4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure



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


  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Death
    • Symptom - Hiding
    • Symptom - Lethargy
    • Symptom - Malaise

12. How long did the symptoms last?

Persisted until death

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


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?


Day(s) / Jour(s)

15. Outcome of the incident


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

1-43089122 - The reporter, a pet owner, indicated that his dog had been exposed to an herbicide containing the active ingredient paraquat. The reporter was not able to provide an EPA registration number for the product but did state that the name of the product was Gramoxone. The reporter is a farmer and he purchased the product from a chemical company. The reporters father applied the product to the reporters lawn five days prior to initial contact with the registrant. The reporter did not know if his father diluted the product before it was applied but he did indicate that his three dogs entered the application site while the product was still wet. Two days after the exposure the reporters 5 year old, female, 4 pound miniature Pinscher (Subform III #1) began hiding and was not feeling well. At the time of the initial call, this dog was also not eating and seemed lethargic. The reporters two bigger dogs were also lethargic, not eating, they both had sores in their mouths and one of them was drooling. On follow-up call, two days later, the reporter indicated that the little dog had died that morning at the veterinary clinic. The dog had been at the clinic for the past three days and the veterinarian had indicated that he thought the dog had a stroke. The other two dogs had been treated by the veterinarian and at the time of the follow-up call they were home and doing better, although the sores in their mouth was making it hard for them to eat. No additional information is available.

To be determined by Registrant

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


19. Provide supplemental information here