Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5298

2. Registrant Information.

Registrant Reference Number: Prosar 1-20757516

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.

17-NOV-09

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

17-NOV-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. 26509      PMRA Submission No.       EPA Registration No.

Product Name: Prelude 240

• Active Ingredient(s)
  • PERMETHRIN

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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 by a Pest Control Operator on 11/17/2009.

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.

Data Subject

2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Irritated throat
  • Symptom - Tingling in mouth
  • Specify - "Tingling in throat"

4. How long did the symptoms last?

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

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

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Drift from the application site

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.

Respiratory

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

1-20757516: A reporter called on 11/17/2009 to report his exposure to an insecticide containing the active ingredient Permethrin. According to the reporter, a pest control operator was applying the diluted product to the outside of the home on 11/17/2009. The reporter opened the front door for a moment and inhaled the product fumes. He developed a tingling and some irritation in the back of his throat. The reporter was advised that inhalation of the product mist may result in irritation of the eyes and upper respiratory tract including cough, difficulty breathing, and shortness of breath. These signs are typically limited to the upper respiratory tract and resolve without affecting other body functions. If skin exposure occurs, a burning, itching, numb, or tingling sensation may develop. This sensation typically resolves within 24 hours. A recommendation was made to get away from the source of the odor into fresh air. A recommendation was also made to seek medical attention should shortness of breath or difficulty breathing develop. On follow up, the reporter stated that his signs resolved within 24 hours. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.