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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-3482

2. Registrant Information.

Registrant Reference Number: 170073584

Registrant Name (Full Legal Name no abbreviations): AMVAC Chemical Corporation

Address: 4695 MacArthur Court

City: Newport Beach

Prov / State: California

Country: USA

Postal Code: 92660

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.


5. Location of incident.



6. Date incident was first observed.


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.


PMRA Registration No. 29000      PMRA Submission No.       EPA Registration No. 241-257

Product Name: Thimet 20G

  • Active Ingredient(s)
      • Guarantee/concentration 20 %

7. b) Type of formulation.


Application Information

8. Product was applied?


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?


Subform III: Domestic Animal Incident Report

1. Source of Report


2. Type of animal affected

Dog / Chien

3. Breed


4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )


8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms


  • General
    • Symptom - Death

12. How long did the symptoms last?

Unknown / Inconnu

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


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


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

The dog had access to a treated peanut field for approx. 1 hr. in the morning. When the owner returned home from work at 3pm, the dog was deceased. The owner found vomit and diarrhea all over the home and the piles appeared to contain a large amount of peanuts from the field. No medical treatment was rendered. The amount of exposure is unknown.

To be determined by Registrant

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


19. Provide supplemental information here

The day before the exposure, the peanut fields around the owner's home were treated with Syngenta Dynasty products. Active ingredients for field treatments were provided by the farmer to the owner. (Azoxystrobin, Metalaxyl-M, Fludioxonil and Phorate) The date(s) of phorate treatment is unknown. Because the time course was somewhat consistent, the amount was unknown, and the findings were generally consistent, phorate was considered to have a medium likelihood as the cause of death. It is noted that the EPA registration number provided was for the previous registrant of this product. The last EPA approved label with this registration number (241-257) is dated 2000. The product line was acquired by AMVAC in 2006.