Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-5188

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-41633400

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.

Human

4. Date registrant was first informed of the incident.

19-AUG-15

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

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. 100-1066

Product Name: Demand CS

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN
    • Guarantee/concentration 9.7 %

---

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Pub. Area - Outdoor/Zone publique - ext

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 II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Male

Age: >12 <=19 yrs / >12 <=19 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Other
  • Specify - Non-cancerous tumors in the mouth and parotid gland

• Nervous and Muscular Systems
  • Symptom - Other
  • Specify - learning disability

• Eye
  • Symptom - Other
  • Specify - one eye changed color from blue to green

• Nervous and Muscular Systems
  • Symptom - Headache

• Gastrointestinal System
  • Symptom - Irritated throat

• Skin
  • Symptom - Irritated skin

• Eye
  • Symptom - Irritated eye

• Gastrointestinal System
  • Symptom - Nausea

• Nervous and Muscular Systems
  • Symptom - Irritable

• General
  • Symptom - Other
  • Specify - gynecomastia

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Skin

Oral

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-41633400 - The reporter indicated that he, his family and his neighbors had been exposed to an insecticide containing the active ingredient Lambda-cyhalothrin and to many other non-registrant products with unknown active ingredients. The reporter stated that for the past 10 years the mosquito control department has been using helicopters and trucks to apply 23 different chemicals on the island where his family lives. The reporter indicated that the residents were never alerted when the chemicals were applied so they have been breathing the mist and getting it on their skin. The reporter also indicated that he and his neighbors do not have municipal water, so they collect rain water off of the roof into cisterns for all of their water needs (drinking, washing, etc.) The reporter is therefore concerned that they have been ingesting the chemicals in their water. The reporter indicated that for the past 10 years his (age) year old son (Subform II #1) has been having a lot of medical issues: He has had tumors (not cancerous) in his mouth and parotid gland over the years that have been removed, one of his eyes turned from blue to green, he has learning disabilities including a recent increase in irritability, he has headaches, his throat bothers him and whenever the product is sprayed he develops nausea and eye and skin irritation. The reporter also indicated that his son has developed gynecomastia. The reporter also stated that he has two female neighbors that have both been diagnosed with breast cancer. Per the reporter both of these women are dying and are currently on ventilators. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Neoplasia

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Skin

Oral

Respiratory

11. What was the length of exposure?

>1 yr / > 1 an

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-41633400 - The reporter indicated that he, his family and his neighbors had been exposed to an insecticide containing the active ingredient Lambda-cyhalothrin and to many other non-registrant products with unknown active ingredients. The reporter stated that for the past 10 years the mosquito control department has been using helicopters and trucks to apply 23 different chemicals on the island where his family lives. The reporter indicated that the residents were never alerted when the chemicals were applied so they have been breathing the mist and getting it on their skin. The reporter also indicated that he and his neighbors do not have municipal water, so they collect rain water off of the roof into cisterns for all of their water needs (drinking, washing, etc.) The reporter is therefore concerned that they have been ingesting the chemicals in their water. The reporter indicated that for the past 10 years his (age) year old son (Subform II #1) has been having a lot of medical issues: He has had tumors (not cancerous) in his mouth and parotid gland over the years that have been removed, one of his eyes turned from blue to green, he has learning disabilities including a recent increase in irritability, he has headaches, his throat bothers him and whenever the product is sprayed he develops nausea and eye and skin irritation. The reporter also indicated that his son has developed gynecomastia. The reporter also stated that he has two female neighbors that have both been diagnosed with breast cancer. Per the reporter both of these women are dying and are currently on ventilators. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Neoplasia

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Skin

Oral

Respiratory

11. What was the length of exposure?

>1 yr / > 1 an

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-41633400 - The reporter indicated that he, his family and his neighbors had been exposed to an insecticide containing the active ingredient Lambda-cyhalothrin and to many other non-registrant products with unknown active ingredients. The reporter stated that for the past 10 years the mosquito control department has been using helicopters and trucks to apply 23 different chemicals on the island where his family lives. The reporter indicated that the residents were never alerted when the chemicals were applied so they have been breathing the mist and getting it on their skin. The reporter also indicated that he and his neighbors do not have municipal water, so they collect rain water off of the roof into cisterns for all of their water needs (drinking, washing, etc.) The reporter is therefore concerned that they have been ingesting the chemicals in their water. The reporter indicated that for the past 10 years his (age) year old son (Subform II #1) has been having a lot of medical issues: He has had tumors (not cancerous) in his mouth and parotid gland over the years that have been removed, one of his eyes turned from blue to green, he has learning disabilities including a recent increase in irritability, he has headaches, his throat bothers him and whenever the product is sprayed he develops nausea and eye and skin irritation. The reporter also indicated that his son has developed gynecomastia. The reporter also stated that he has two female neighbors that have both been diagnosed with breast cancer. Per the reporter both of these women are dying and are currently on ventilators. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.