Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-3121

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #:1-43904458

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-APR-16

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

25-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)

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PMRA Registration No. 27577      PMRA Submission No.       EPA Registration No. Unknown

Product Name: APRON MAXX RTA SEED TREATMENT FUNGICIDE

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

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

Product Name: VIBRANCE 500FS SEED TREATMENT

• Active Ingredient(s)
  • SEDAXANE

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7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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

Site: Unknown / Inconnu

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

Labrador Retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

75

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

• General
  • Symptom - Hyperthermia

• Nervous and Muscular Systems
  • Symptom - Muscle twitching

• General
  • 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?

Unknown

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

1-43904458- The reporter, a veterinarian, indicated that a clients dog had been exposed to seeds coated with the active ingredients fludioxonil, metalaxyl-m (mefenoxam), and sedaxane. The reporter indicated that the 8-year-old, 75-pound, male Labrador Retriever dog ate an unknown number of the treated seeds on the day of contact with the registrant. The dog had hyperthermia and was twitching. The reporter was informed that the pets symptoms would not be expected with ingestion of these active ingredients, and symptomatic and supportive care was recommended. On a follow-up call 3 days later, the reporter stated the dog had died. The reporter suspected the dog died of strychnine poisoning. No additional information is available.

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To be determined by Registrant

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

Death

19. Provide supplemental information here