Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-1297

2. Registrant Information.

Registrant Reference Number: Prosar 1-17945312

Registrant Name (Full Legal Name no abbreviations): FMC Corporation

Address: 1735 Market Street

City: Philadelphia

Prov / State: Pennsylvania

Country: USA

Postal Code: 19103

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

28-MAR-09

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

27-MAR-09

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.

Product Name: Non-specific Dragnet (Permethrin-based Insecticide)

• Active Ingredient(s)
  • PERMETHRIN
    • Unknown

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7. b) Type of formulation.

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 the lawn and the exterior of the home on 03/27/2009. A non-company product was applied at the same time to the attic spaces.

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

Gold fish

4. Number of animals affected

1

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?

Other / Autre

specify Unknown

17. Provide any additional details about the incident

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

1-17945312: A reporter called on 03/28/2009 to report the possible exposure of a fish to an insecticide containing the active ingredient Permethrin. According to the reporter, a pest control operator applied the product to the lawn and the exterior perimeter of the home on 03/27/2009. A non-company product was applied in the attic spaces at the same time. The reporter stated that a gold fish was found dead when the reporter returned home following product application. The reporter was advised that people and pets should not be allowed on treated surfaces until the product has dried. The reporter was also advised that because the product was applied outside the home, it is unlikely the fish had any exposure to the product. A recommendation was made to contact the non-company product's health and safety department or the pest control agency for further information regarding that product. No further information was obtained.

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To be determined by Registrant

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

Death

19. Provide supplemental information here