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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5939

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15140112

Registrant Name (Full Legal Name no abbreviations): Syngenta Crop Protection

Address: 410 Swing Road

City: Greensboro

Prov / State: North Carolina

Country: USA

Postal Code: 27419

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: TENNESSEE

6. Date incident was first observed.


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.       PMRA Submission No.       EPA Registration No.

Product Name: Demand CS - EPA: 100-1066

  • Active Ingredient(s)
      • Guarantee/concentration 9.79 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


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).

Crack -n- crevice and baseboard treatment. They also treated under the furniture. In addition, PCO treated the attic and crawl space with ULV and dusted any voids (maybe including the attic).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform III: Domestic Animal Incident Report

1. Source of Report


2. Type of animal affected

Other / Autre

specify Snake

3. Breed

Unknown Breed

4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )


8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>1 wk <=1 mo / > 1 sem < = 1 mois

11. List all symptoms


  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

Incident Date / Location: 05/30/07 / (City, State) Registrant Aware Date: 06/08/07 Description of incident: Information transcribed from e-mail's Pest Control company explained that approximately 1 1/2 week ago, his company treated the home in question for Brown Recluse spiders. The treatments included Demand CS used indoors as a crack n crevice and baseboard treatment. They also treated under the furniture. In addition, PCO treated the attic and crawl space with ULV and dusted any voids (maybe including the attic). Prior to any treatment, PCO was careful to have the homeowner in question remove any pets from the inside. PCO suggested that the homeowner not re-enter the home with the snake until at least 12 hours after the treatment. Made note that there is not a specific re-entry period on the Demand CS label. Mentioned that the homeowner allowed the snake to "run free" in the home after re-entry. Unfortunately, the snake died, but to my knowledge from PCO¿¿¿s comments not for 1 1/2 weeks after the treatment date. The homeowners took the snake to the local PetCo pet store. The pet store diagnosed death from pesticide exposure. Follow-Up information: Follow-up from PCO - Very important - (homeowner with snake), did not take the snake out of the terrarium either while outside or after re-entering the home. Therefore, the snake would not have been directly exposed to any treatment surface residue. Also mentioned that the PCO had treated an apartment where Owner lived prior to moving into this location. Assumes, then, that the snake was at the apartment, as well. Final note. PetCo explained when diagnosing the cause of death that the customer should have kept the snake out for at least 2 days. That small amounts of pesticide exposure would kill the snake. Snake died 6/8/07.

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification


19. Provide supplemental information here