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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-3074

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #1-44233013

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.

25-MAY-16

5. Location of incident.

Country: UNITED STATES

Prov / State: SOUTH CAROLINA

6. Date incident was first observed.

22-MAY-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. Unknown

Product Name: Treated Peanuts or Soybeans

  • Active Ingredient(s)
    • AZOXYSTROBIN
      • Unknown
    • FLUDIOXONIL
      • Unknown
    • METALAXYL-M (MEFENOXAM)
      • Unknown

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

Unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

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

  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
  • Gastrointestinal System
    • Symptom - Constipation
  • General
    • Symptom - Lethargy

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-44233013 - The reporter, a pet owner, indicated that her dog may have been exposed to a pesticide with the active ingredients Azoxystrobin, Fludioxonil, and Metalaxyl-M (mefenoxam). Three days before initial contact with the registrant, the reporter indicated that her dog of unknown breed, gender, age and weight ingested an unknown amount of the product and subsequently developed lethargy, tremors and constipation at an unknown amount of time after this ingestion. The dog died after an unknown amount of time after symptoms appeared, but before initial contact with the registrant. 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

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

Female

6. Age (provide a range if necessary )

12

7. Weight (provide a range if necessary )

30

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

  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
  • Cardiovascular System
    • Symptom - Abnormally fast heart rate
  • General
    • Symptom - Dehydration
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Yes

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-44233013 - The reporter, a pet owner, indicated that her dog may have been exposed to a pesticide with the active ingredients Azoxystrobin, Fludioxonil, and Metalaxyl-M (mefenoxam). One day before initial contact with the registrant, the reporter indicated that her female, 12-year-old, 30-pound, Jack Russell Terrier dog ingested an unknown amount of the product. On the day of contact with the registrant, the reporter brought the dog to the veterinarian because of lethargy and tremors. The dog died two hours after presentation at the veterinary clinic. The reporter was told the products are at low concentration and may cause mild gastrointestinal irritation, but some of the symptoms do not seem consistent with product ingestion. The veterinarian later spoke with the registrant and stated the dog was also dehydrated, had tachycardia, and was positive for heartworm disease. 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