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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-5994

2. Registrant Information.

Registrant Reference Number: Prosar 1-16801073

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.

30-OCT-08

5. Location of incident.

Country: UNITED STATES

Prov / State: HAWAII

6. Date incident was first observed.

28-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.

Product Name: Permethrin Based Insecticide (non-specific Prelude)

  • Active Ingredient(s)
    • PERMETHRIN
      • Unknown

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 product was applied to a plastic trough on an unknown date near a pond where some fish were kept.

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

Koi

4. Number of animals affected

10

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.

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?

Spray drift / Dérive de pulvérisation

17. Provide any additional details about the incident

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

1-16801073: A reporter called on 10/30/2008 to report the exposure of some fish to an insecticide containing the active ingredient Permethrin. According to the reporter, the product was sprayed into a plastic trough on an unknown date near a pond where the fish were kept. Ten koi died on 10/28/2008 (1st Subform III). The signs preceding death are unknown. The reporter then cleaned the pond with Dawn dish soap and refilled it with water. He bought some guppies and put them in the pond after cleaning and refilling it. The guppies also died (date of deaths unknown; 2nd Subform III). The reporter wanted to know how to clean the pond out. The reporter was advised that the active ingredient in the product is very toxic to aquatic organisms. The reporter was also advised that the product may cause long-term adverse effects in the aquatic environment. A recommendation was made for the reporter to contact the consumer services department for complete information regarding cleaning the pond. No further information was obtained.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Fish / Poisson

3. Breed

Guppies

4. Number of animals affected

2

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.

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?

Spray drift / Dérive de pulvérisation

17. Provide any additional details about the incident

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

1-16801073: A reporter called on 10/30/2008 to report the exposure of some fish to an insecticide containing the active ingredient Permethrin. According to the reporter, the product was sprayed into a plastic trough on an unknown date near a pond where the fish were kept. Ten koi died on 10/28/2008 (1st Subform III). The signs preceding death are unknown. The reporter then cleaned the pond with Dawn dish soap and refilled it with water. He bought some guppies and put them in the pond after cleaning and refilling it. The guppies also died (date of deaths unknown; 2nd Subform III). The reporter wanted to know how to clean the pond out. The reporter was advised that the active ingredient in the product is very toxic to aquatic organisms. The reporter was also advised that the product may cause long-term adverse effects in the aquatic environment. A recommendation was made for the reporter to contact the consumer services department for complete information regarding cleaning the pond. No further information was obtained.


To be determined by Registrant

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

Death

19. Provide supplemental information here