Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-5875

2. Registrant Information.

Registrant Reference Number: Prosar 1-16724446

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.

09-OCT-08

5. Location of incident.

Country: UNITED STATES

Prov / State: ILLINOIS

6. Date incident was first observed.

09-OCT-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)

---

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?

Unknown

9. Application Rate.

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

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

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.

Medical Professional

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 - Unconsciousness

• Cardiovascular System
  • Symptom - Cardiac arrest

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Occupational

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

Other

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?

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.)

1-16724446: A reporter (pharmacist) called on 10/09/2008 to report the exposure of a male pest control operator to an insecticide containing the active ingredient Cypermethrin. According to the reporter, the man had been found unconscious on a lawn earlier in the day with a container of the product near him. The man had been admitted to the hospital and the reporter was calling to find out the toxicity of the product and any specific treatment protocols. The reporter was advised that the product has a wide margin of safety and low level of toxicity. The reporter was also advised that inhalation of the product may result in ocular and upper respiratory tract irritation resulting in coughing, difficulty breathing, and shortness of breath. Patients who smoke or have underlying respiratory conditions may experience more pronounced symptoms. In these patients, previously prescribed inhalers or nebulizer therapy may be indicated for acute respiratory symptoms. The reporter was advised that product exposure would not be expected to result in the signs described. The product's Material Safety Data Sheet (MSDS) was faxed to the reporter and the reporter was encouraged to call back with further questions. On follow up later on 10/09/2008, a hospital employee stated that the patient had been in cardiac arrest and had been resuscitated. No toxicology tests had been run, and the patient had been transferred to the intensive care unit (ICU) at another medical facility. On follow up with the other medical facility on 10/09/2008, a reporter stated that the patient was still settling into the ICU. The reporter also stated that no further information could be given out unless the patient's family called directly to provide it. No further information was obtained. NOTE: Details of this case (including route of exposure, initial symptoms, time frame with respect to product exposure and development of symptoms, patient's pertinent medical history, and eventual diagnosis) are unknown. Actual product exposure was not witnessed.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

Details of this case (including route of exposure, initial symptoms, time frame with respect to product exposure and development of symptoms, patient's pertinent medical history, and eventual diagnosis) are unknown. Actual product exposure was not witnessed. The signs described are not consistent with routine product use.