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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-2856
2. Registrant Information.
Registrant Reference Number: ProPharma Group case #: 1-44110665
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.
13-MAY-165. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
13-MAY-16Product 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. 31300 PMRA Submission No. EPA Registration No.
Product Name: MASTERLINE LAMBDACY 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
- Gastrointestinal System
- Symptom - Nausea
- Symptom - Vomiting
- Eye
- Symptom - Irritated eye
- Skin
- Symptom - Other
- Specify - Swollen around temples
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.
>8 hrs <=24 hrs / > 8 h < = 24 h
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.)
1-44110665 - The reporter indicated he and his wife 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 their home about one day prior to initial contact with the registrant. They re-entered their home at an unknown time on the day the product was applied, and ventilated the house by opening windows as the wife was bothered by the product odor. On the morning of the day of initial contact with the registrant, the reporters wife complained of nausea, vomiting, irritated eyes, and a swollen area around her temples. The reporter was asymptomatic. The reporter was advised that inhalation of the fumes may cause transient respiratory and ocular irritation. On follow-up call four days after initial contact with the registrant, the reporter indicated his wife still had no energy, but the vomiting had resolved. She had not yet been evaluated by a doctor. The reporter was advised to seek medical care for his wife if her symptoms did not resolve soon, as symptoms from the product are not generally this persistent. No additional information is available.
To be determined by Registrant
14. Severity classification.
Minor
