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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-3122

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #1-44129619

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.

16-MAY-16

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

14-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. 100-816

Product Name: DUAL MAGNUM HERBICIDE

  • Active Ingredient(s)
    • S-METOLACHLOR AND R-ENANTIOMER
      • Guarantee/concentration 915 g/L

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: unknown

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

Cat / Chat

3. Breed

Siamese

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

13

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
  • Gastrointestinal System
    • Symptom - Foaming at mouth
    • Symptom - Vomiting
    • Symptom - Fecal incontinence
  • Eye
    • Symptom - Glazed eye
    • Symptom - Pupil dilation
  • Nervous and Muscular Systems
    • Symptom - Seizure
  • Eye
    • Symptom - Blindness (permanent)

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-44129619 - The reporter, a pet owner, indicated that her cat may have been exposed to a pesticide with the active ingredients S-metolachlor and R-enantiomer. Two days before initial contact with the registrant, the reporter indicated that her 13-year-old, male, Siamese cat of unknown weight suddenly developed foaming at the mouth, vomiting, dilated pupils, and lost control of his bowels. On the same day, the cat was brought to a veterinarian where he developed blindness, glassy eyes, seizures, and eventually died. The reporter stated that on the morning the cat became ill, the product had been applied to a field, but it had been incorporated into the soil. The reporter found traces of the product on the ground where the tractor had left the field and surmised that this is where cats exposure may have happened, but no actual exposure was observed. The reporter was offered condolences for the pets passing, and the option of necropsy was discussed, but the cat had already been buried. 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