Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-0981

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-46960175

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.

26-JAN-17

5. Location of incident.

Country: UNITED STATES

Prov / State: IDAHO

6. Date incident was first observed.

Unknown

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. 100-1313

Product Name: QUADRIS TOP SB FUNGICIDE

  • Active Ingredient(s)
    • AZOXYSTROBIN
      • Guarantee/concentration 18.2 %
    • DIFENOCONAZOLE
      • Guarantee/concentration 11.4 %

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: Potato

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

Other

2. Type of animal affected

Cow / Vache

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

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.

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?

Spray drift / Dérive de pulvérisation

17. Provide any additional details about the incident

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

1-46960175 - The reporter, a lawyer, indicated a cow may have been exposed to a pesticide with the active ingredients azoxystrobin and difenoconazole. On the day of initial contact with the registrant, the reporter indicated a cow of unknown age, breed, weight or gender had accidently been sprayed with the product by an aerial sprayer five-and-one-half years before. Veterinary evaluation of the cow at an unknown time after exposure concluded that there was no treatment. The reporter did not know what symptoms the cow exhibited before death, but indicated the cow had died an unknown amount of time after the exposure. 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

Other

2. Type of animal affected

Bird - Poultry / Oiseau - Volaille

3. Breed

Chicken

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

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.

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?

Spray drift / Dérive de pulvérisation

17. Provide any additional details about the incident

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

1-46960175 - The reporter, a lawyer, indicated that chickens may have been exposed to a pesticide with the active ingredients azoxystrobin and difenoconazole. On the day of initial contact with the registrant, the reporter indicated an unknown number of chickens of unknown age, breed, weight or gender had accidently been sprayed with the product by an aerial sprayer five-and-one-half years before. Veterinary evaluation of the chickens at an unknown time after exposure concluded that there was no treatment. The reporter did not know what symptoms the chickens exhibited before death, but indicated the chickens had died an unknown amount of time after the exposure. 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