Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2697

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16166274

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

Address: 140 Research Lane

City: Guelph

Prov / State: Ontario

Country: Canada

Postal Code: N1G 4Z3

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

Domestic Animal

4. Date registrant was first informed of the incident.

19-MAY-08

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

17-MAY-08

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1000

Product Name: Demon WP in Water-Soluble Packets

• Active Ingredient(s)
  • CYPERMETHRIN
    • Guarantee/concentration 40 %

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7. b) Type of formulation.

Dust

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Res. - Out Home / Rés - à l'ext.maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

The reporter sprayed the product underneath the deck of his house about 1 week prior to the call (estimated 5/12/08).

To be determined by Registrant

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

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Mixed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

40

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Abdominal distension

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify No witnessed exposure. The reporter presumed the dog inhaled some of the product during application.

17. Provide any additional details about the incident

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

1-16166274: The reporter called on 5/19/08 to inquire about the safety profile of a product containing the active ingredient Cypermethrin. He had sprayed the product underneath the deck of his house about 1 week prior to the call. While there had been no witnessed exposure, according to the reporter his 4 year old dog had become lethargic and had developed a distended abdomen over the previous 2 days. The reporter wondered if the dog's symptoms could be related to product exposure, especially if the dog had inhaled the product during application. The product's potential to be a GI, dermal or respiratory irritant was discussed. The dog's symptoms were determined to be inconsistent with the exposure. A recommendation was made to have the dog evaluated ASAP by a veterinarian. Several follow-up calls were placed, and a return call on 5/28/08 revealed the dog had passed away on en route to a veterinarian. The veterinarian had offered to perform a necropsy, but the reporter had declined.

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To be determined by Registrant

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

Death

19. Provide supplemental information here

The dogs symptoms were inconsistent with the exposure and it is unlikely that the dog died from exposure to this product. There is no evidence of direct exposure.