Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-1227

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-43074047

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.

28-JAN-16

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

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. 27428      PMRA Submission No.       EPA Registration No.

Product Name: Demand CS Insecticide

  • Active Ingredient(s)
    • LAMBDA-CYHALOTHRIN

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: Res. - In Home / Rés. - à l'int. maison

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: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

  • Respiratory System
    • Symptom - Runny nose
    • Symptom - Nasal congestion
    • Symptom - Asthma

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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)

Contact with treated area

What was the activity? Daily living

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.

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.)

1-43074047 - The reporter indicated that he, his wife and daughter had been exposed to an insecticide containing the active ingredient Lambda-cyhalothrin. The reporter stated that the product had been applied by a PCO in his apartment about 23 or 22 days prior to his initial call. The reporter re-entered his home 6 hours after the product had been applied but his wife and 7 month old daughter re-entered the home 3-5 days after the product had been applied. The reporter indicated that during the 3-5 days his wife was away he kept the windows open to ventilate the apartment but he developed diarrhea and nasal congestion and indicated that when he blew his nose there was a small amount of blood in the mucous. At the time of the call the reporter still had some diarrhea. The daughter was fine when she returned to the apartment but about 2 days prior to the initial call (20-21 days after the product had been sprayed) his wife unpacked some boxes that had been sprayed and about 10-15 minutes after unpacking the boxes the reporter¿¿¿¿¿¿s 7-month-old daughter started sneezing and on the morning of initial contact they found that she had a slight fever. The reporter¿¿¿¿¿¿s wife indicated that she had asthma or allergy type symptoms, persistent nasal discharge, a stuffy nose, and it felt like she had a head cold. She did not indicate when these symptoms had developed or how long they had been present. The reporter was advised that inhalation of the fumes may cause transient respiratory irritation. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

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: <=1 yr / < = 1 an

3. List all symptoms, using the selections below.

System

  • Respiratory System
    • Symptom - Sneezing
  • General
    • Symptom - Fever

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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)

Contact with treated area

What was the activity? Daily living

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.

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.)

1-43074047 - The reporter indicated that he, his wife and daughter had been exposed to an insecticide containing the active ingredient Lambda-cyhalothrin. The reporter stated that the product had been applied by a PCO in his apartment about 23 or 22 days prior to his initial call. The reporter re-entered his home 6 hours after the product had been applied but his wife and 7 month old daughter re-entered the home 3-5 days after the product had been applied. The reporter indicated that during the 3-5 days his wife was away he kept the windows open to ventilate the apartment but he developed diarrhea and nasal congestion and indicated that when he blew his nose there was a small amount of blood in the mucous. At the time of the call the reporter still had some diarrhea. The daughter was fine when she returned to the apartment but about 2 days prior to the initial call (20-21 days after the product had been sprayed) his wife unpacked some boxes that had been sprayed and about 10-15 minutes after unpacking the boxes the reporter¿¿¿¿¿¿s 7-month-old daughter started sneezing and on the morning of initial contact they found that she had a slight fever. The reporter¿¿¿¿¿¿s wife indicated that she had asthma or allergy type symptoms, persistent nasal discharge, a stuffy nose, and it felt like she had a head cold. She did not indicate when these symptoms had developed or how long they had been present. The reporter was advised that inhalation of the fumes may cause transient respiratory irritation. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

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

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

  • Gastrointestinal System
    • Symptom - Diarrhea
  • Respiratory System
    • Symptom - Nasal congestion
    • Symptom - Nose bleed

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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)

Contact with treated area

Amount of time between application and contact 6

Hour(s) / Heure(s)

What was the activity? Daily living

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.

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.)

1-43074047 - The reporter indicated that he, his wife and daughter had been exposed to an insecticide containing the active ingredient Lambda-cyhalothrin. The reporter stated that the product had been applied by a PCO in his apartment about 23 or 22 days prior to his initial call. The reporter re-entered his home 6 hours after the product had been applied but his wife and 7 month old daughter re-entered the home 3-5 days after the product had been applied. The reporter indicated that during the 3-5 days his wife was away he kept the windows open to ventilate the apartment but he developed diarrhea and nasal congestion and indicated that when he blew his nose there was a small amount of blood in the mucous. At the time of the call the reporter still had some diarrhea. The daughter was fine when she returned to the apartment but about 2 days prior to the initial call (20-21 days after the product had been sprayed) his wife unpacked some boxes that had been sprayed and about 10-15 minutes after unpacking the boxes the reporter¿¿¿¿¿¿s 7-month-old daughter started sneezing and on the morning of initial contact they found that she had a slight fever. The reporter¿¿¿¿¿¿s wife indicated that she had asthma or allergy type symptoms, persistent nasal discharge, a stuffy nose, and it felt like she had a head cold. She did not indicate when these symptoms had developed or how long they had been present. The reporter was advised that inhalation of the fumes may cause transient respiratory irritation. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.