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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-3911

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-53287026

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.

23-JUL-18

5. Location of incident.

Country: UNITED STATES

Prov / State: SOUTH DAKOTA

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. 100-1385

Product Name: FLEXSTAR GT 3.5

  • Active Ingredient(s)
    • FOMESAFEN
      • Guarantee/concentration 5.88 %
    • GLYPHOSATE
      • Guarantee/concentration 22.4 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1070

Product Name: FUSILADE DX HERBICIDE

  • Active Ingredient(s)
    • FLUAZIFOP-P-BUTYL
      • Guarantee/concentration 24.5 %

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).

1-53287026 - The reporter stated that the following non-company products were applied at the same time. Buccaneer Plus Glyphosate (Manufacturer: Tenkoz)EPA 55467-9; Plexus II (Network of Adjuvant components - modified alkanoates, polymers and surfactants) (Manufacturer: Rosen's Inc); and AMS (Ammonium Sulfate).

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

Sheep / Mouton

3. Breed

Unknown

4. Number of animals affected

2

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

  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Unknown

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

1-53287026 - The reporter, an animal owner, indicates an exposure to pesticides containing the active ingredients fomesafen, glyphosate, and fluazifop-p-butyl. Seventeen days before the day of initial contact with the registrant, the reporter indicated field near his property was sprayed with the product and some wind overspray might have had contact with his two sheep of unknown age, weight, breed and gender. Six days before the day of initial contact, the two sheep died after an unknown number of days of progressive anorexia. The reporter was advised the symptoms would not be expected from the described 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

Animal's Owner

2. Type of animal affected

Cow / Vache

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Female

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
  • Gastrointestinal System
    • Symptom - Anorexia
  • Reproductive System
    • Symptom - Other
    • Specify - decreased milk production

12. How long did the symptoms last?

Persisted until death

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

Unknown

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

1-53287026 - The reporter, an animal owner, indicates an exposure to pesticides containing the active ingredients fomesafen, glyphosate, and fluazifop-p-butyl. Seventeen days before the day of initial contact with the registrant, the reporter indicated field near his property was sprayed with the product and some wind overspray might have had contact with his female cow of unknown age, weight, and breed. Five days before the day of initial contact, the cow died after an unknown number of days of progressive anorexia and decreased milk production. The reporter was advised the symptoms would not be expected from the described 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