Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-1390

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-62806203

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.

02-JAN-21

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

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)

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PMRA Registration No. 25585      PMRA Submission No.       EPA Registration No.

Product Name: APRON XL LS FUNGICIDE

• Active Ingredient(s)
  • METALAXYL-M (MEFENOXAM)
    • Guarantee/concentration 33.3 %

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Mixed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

90

lbs

8. Route(s) of exposure

Oral

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 - Vomiting

• Nervous and Muscular Systems
  • Symptom - Other
  • Specify - soreness
  • Symptom - Ataxia

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

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

1-62806203 - The reporter, a veterinarian, indicates an exposure to a pesticide containing the active ingredient metalaxyl-M (mefenoxam). Approximately one day before the day of initial contact with the registrant, the reporter stated a 2-year-old, 90-pound, female, mixed breed dog ingested an unknown amount of seed that had been coated with the pesticide. On the day of initial contact, the dog vomited and was walking strangely so the dog's owner presented her to the reporter. On examination, the reporter found soreness in the dog's right hind limb, but the rest of the exam was unremarkable. The reporter was advised that neurological signs would not be expected from the described exposure, and any gastrointestinal upset should be treated symptomatically and supportively. 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

Moderate

19. Provide supplemental information here