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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-3072

2. Registrant Information.

Registrant Reference Number: ProPharma Group case # 1-43694646

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.

04-APR-16

5. Location of incident.

Country: UNITED STATES

Prov / State: UTAH

6. Date incident was first observed.

03-APR-16

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. 100-799

Product Name: Apron XL

  • Active Ingredient(s)
    • METALAXYL-M (MEFENOXAM)
      • Guarantee/concentration 33.3 %

7. b) Type of formulation.

Other (specify)

Treated grass seed

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Res. - Out Home / Rés - à l'ext.maison

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

Chihuahua

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1.5

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

Unknown / Inconnu

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-43694646 - The reporter, a pet owner, indicated that her dog may have been exposed to grass seed treated with the active ingredient mefenoxam. The reporter put out the grass seed on her lawn two days prior to initial contact with the registrant. The following day the reporter left her 1.5 year old, female Chihuahua dog alone on the lawn for a period of 5 minutes while she answered the phone. When she came back outside the dog was found dead. The reporter indicated that the dog had been completely fine prior to her leaving 5 minutes earlier. Although no direct exposure to the grass seed was indicated the reporter was concerned that walking on the applied grass seed may have been the reason for the dogs death. The reporter was advised that the described symptoms are not consistent with the described exposure to the product and a necropsy was recommended to determine an underlying cause for the dogs death. The reporter stated that she had submitted the dog for a necropsy but she did not yet have the results. The reporter could not be reached on routine follow-up attempts. No additional 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