Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-3842

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-16580663

Registrant Name (Full Legal Name no abbreviations): Syngenta USA

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.

28-AUG-08

5. Location of incident.

Country: UNITED STATES

Prov / State: MINNESOTA

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. 100-1000

Product Name: Demon WP in Water-Soluble Packets

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

---

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. - 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 outside the door of her home with diluted spray sometime within six months of the call.

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

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.33

7. Weight (provide a range if necessary )

4

lbs

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

• Nervous and Muscular Systems
  • Symptom - Depression
  • Symptom - Difficulty getting up

• Gastrointestinal System
  • Symptom - Vomiting

• General
  • Symptom - Dehydration
  • 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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-16580663: A reporter (veterinarian) called on 08/28/2008 to report the possible accidental exposure of a 4 month-old kitten to an insecticide spray containing the active ingredient Cypermethrin. According to the reporter, the consumer was spraying the diluted product underneath a door where the kitten could have been exposed to it on 08/28/2008. The reporter stated that the kitten became depressed, weak, was unable to sit up, vomited one time, and was dehydrated. The reporter was advised of the active ingredient toxicity profile and expected signs with exposure. A recommendation was made to rule out other possible causes for signs as the described symptoms were not completely consistent with product exposure. The reporter was advised that treatment for product exposure is symptomatic and supportive. A follow up call was made to the reporter on 08/29/2008, and the reporter stated that the kitten had died and a necropsy was not planned. No further information was reported.

---

To be determined by Registrant

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

Death

19. Provide supplemental information here

No direct exposure has been documented, symptoms inconsistent with exposure to Cypermethrin.