Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4102

2. Registrant Information.

Registrant Reference Number: Prosar 1-16640817

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.

Human

4. Date registrant was first informed of the incident.

16-SEP-08

5. Location of incident.

Country: UNITED STATES

Prov / State: MISSOURI

6. Date incident was first observed.

10-SEP-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. 100-1066

Product Name: Demand CS

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN
    • Guarantee/concentration 9.7 %

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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. - 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 product was applied inside the home 90 days prior to the report, and again on 09/09/2008.

To be determined by Registrant

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

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Seizure

• General
  • Symptom - Anaphylactic shock

• Eye
  • Symptom - Swollen eye

• Gastrointestinal System
  • Symptom - Tongue swelling

4. How long did the symptoms last?

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

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

6

Day(s) / Jour(s)

7. Exposure scenario

Non-occupational

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

Contact with treated area

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

Unknown

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

>24 hrs <=3 days / >24 h <=3 jours

12. Time between exposure and onset of symptoms.

>8 hrs <=24 hrs / > 8 h < = 24 h

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.)

1-16640817: A reporter called on 09/16/2008 to report the exposure of her husband to a pyrethroid insecticide containing the active ingredient Lambda-Cyhalothrin. According to the reporter, the product was applied inside the home 90 days prior to the report and again on 09/09/2008. Her husband experienced what the reporter called "anaphylatic shock" with ocular swelling and tongue swelling on 09/10/2008 and 09/12/2008. The reporter stated that her husband was hospitalized overnight after the 09/10/2008 incident. He was hospitalized and remained hospitalized and under treatment for the 09/12/2008 incident at the time of the report. His treatment at the time of the report included IV fluids, steroids, and antihistamines. The reporter said that the attending physician would discharge her husband from the hospital with an epinephrine pen once the product was cleaned from the home. The reporter was advised that her husband's presumed reaction to the product is not expected with routine product use. A recommendation was made that detergent and water is typically all that is needed to remove the product from surfaces, however, the reporter was encouraged to call the customer service department for more specific product removal instructions. On follow up, the reporter stated that her husband's physicians thought his signs resulted from a reaction to the product. The reporter had her house cleaned, and her husband was discharged after six days in the hospital. At the time of follow up, her husband was feeling much better and was taking several medications. No further information was obtained. Note:A representative of the pest control company that had applied the product also called on 9/16/08 and had indicated that the patient had had an epileptic seizure (date unknown).

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.