Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-4384
2. Registrant Information.
Registrant Reference Number: Prosar 1-19716309
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.
05-AUG-09
5. Location of incident.
Country: UNITED STATES
Prov / State: MICHIGAN
6. Date incident was first observed.
01-AUG-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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 279-3141
Product Name: Astro Insecticide
- Active Ingredient(s)
- PERMETHRIN
- Guarantee/concentration 36.8 %
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: Unknown / Inconnu
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 an unknown location on 07/28/2009.
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
Other
2. Type of animal affected
Fish / Poisson
3. Breed
Koi
4. Number of animals affected
5
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
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
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?
Other / Autre
specify Unknown
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-19716309: A reporter (tree service employee) called on 08/05/2009 to report the possible exposure of fish to an insecticide containing the active ingredient Permethrin. According to the reporter, the product had been applied to an unknown location at an unknown rate on 07/28/2009. On 08/01/2009, 1 fish died. More fish died on 08/02/2009. 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
Upon assessing the incident, it appeared that the fish kill occurred several days following product application. Typically, adverse events secondary to Permethrin toxicity occur very soon after exposure.