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: 2008-1413

2. Registrant Information.

Registrant Reference Number: Prosar case 1-15458303

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


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

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. 27428      PMRA Submission No.       EPA Registration No.

Product Name: Demand CS Insecticide

  • Active Ingredient(s)

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).

The caller used the product on 8/1/07. He accidentally mixed it 4x as strong as directed before spraying the product into holes on the chimney in his basement.

To be determined by Registrant

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


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.


  • Skin
    • Symptom - Irritated skin
    • Symptom - Erythema
  • Respiratory System
    • Symptom - Irritated throat
  • Nervous and Muscular Systems
    • Symptom - Headache
  • Respiratory System
    • Symptom - Respiratory irritation
  • Nervous and Muscular Systems
    • Symptom - Numbness
    • Specify - Numbness in head
  • General
    • Symptom - Other
    • Specify - Walking in cobwebs sensation

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


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


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


10. Route(s) of exposure.


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.)

On 8/1 the caller states he mixed the product four times as strong as directed then sprayed the product into the holes on the chimney in his basement. He slept in the house for the next two weeks until he couldn't take the burning anymore. He hasn't been living in his house since that time. Nobody else in the home has been affected except for him. He thought he was over it until he had to put in a new furnace, which he believes caused re-exposure to the product. Since doing this, his face has been red and burning. He has gone to a skin specialist and the specialist doesn't know what to do. The skin specialist he is giving him medication for rosacae. He is also getting headaches that feel like a numbness in his head, his lungs are hurting, and sometimes he has a sore throat and then he will feel OK again. He states that he last attempted to reenter his home about 10 days ago, but had the same sensations intensified. Discussed the toxicity of this product and the low probability of a relationship of current symptoms to product use. Encouraged caller to continue to work with physician to evaluate, diagnose and treat your symptoms.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

The symptoms described above are not an expected result of routine product use. The caller used this product outside of label instructions, mixing the product 4x as strong as it should have been. The product can cause a burning, numbness or tingling sensation but symptoms are expected to resolve within 24 hours of exposure. Once the product has dried, there is little to no risk of product transfer or toxicity.