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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-2880

2. Registrant Information.

Registrant Reference Number: 03June2021 Miravis Ace

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.

Environment

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

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.

PMRA Registration No. 33573      PMRA Submission No.       EPA Registration No. Unknown

Product Name: Miravis Ace

• Active Ingredient(s)
  • PROPICONAZOLE
    • Guarantee/concentration 125 g/L
  • PYDIFLUMETOFEN
    • Guarantee/concentration 150 g/L

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

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 IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Terr. Invrtbrt-Honey Bee/Inv.Ter-Abeille

2. Common name(s)

Honey Bee

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Terrestrial

Salt Water

6. Check all symptoms that apply

Death

7. Describe symptoms and outcome (died, recovered, etc.).

A report was received via email from 3rd party regarding allegations of potential product-related incident(s). The reporter indicated they were aware from information posted on social media of "entire bee yards dying". The reporter indicated that an investigation of potential exposure to a product containing propiconazole and pydiflumetofen is ongoing and samples were collected. No additional information is available.

8. a) Was the incident a result of (select all that apply)

N/A

Unknown

8. b) i) How many times has the product been applied this year?

8. b) ii) What was the date of the last application?

9. Did it rain

9. a) During application?

No

9. b) Up to 3 days after application?

No

10. a) Was there a buffer zone?

No

10. b) What type?

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

No

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

Major

13. Please provide supplemental information here

Information was received indirectly by the registrant via email; reporting has not been received from any parties directly involved in the described report.