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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-3158

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16410303

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.

Domestic Animal

4. Date registrant was first informed of the incident.

17-JUL-08

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

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.       PMRA Submission No.       EPA Registration No. 100-1218

Product Name: Demon Max

  • Active Ingredient(s)
    • CYPERMETHRIN
      • Guarantee/concentration 25.3 %

7. b) Type of formulation.

Liquid

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. - ŕ l'int. maison

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

The reporter used the product for spiders. The timing of use is unknown. The reporter thinks some product got near/into his fish tank.

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

Fish / Poisson

3. Breed

Shad

4. Number of animals affected

200

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Spray drift / Dérive de pulvérisation

17. Provide any additional details about the incident

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

1-16410303: The reporter called on 7/17/08 to report the death of 200 fish (Shad) following possible exposure to a product containing the active ingredient Cypermethrin. According to the reporter, he had used the product at some unknown time to spray for spiders. He thought that some of the product could have gotten in his bait tank, as many of his Shad had died since the time of the application. He stated the bait fish were for his own use. He inquired about the best way to clean the tank to get rid of any residual product. The reporter was advised that the product was highly toxic to aquatic organisms. A recommendation was made to contact customer service regarding clean-up procedures.


To be determined by Registrant

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

Death

19. Provide supplemental information here