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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2679

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-22591921

Registrant Name (Full Legal Name no abbreviations): Syngenta Crop Protection

Address: 410 Swing Road

City: Greensboro

Prov / State: North Carolina

Country: USA

Postal Code: 27419

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

Domestic Animal

4. Date registrant was first informed of the incident.

11-MAY-10

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

11-MAY-10

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. 100-1000

Product Name: DEMON WP

  • Active Ingredient(s)
    • CYPERMETHRIN
      • Guarantee/concentration 40 %

7. b) Type of formulation.

Wettable or soluble powder

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 caller revealed a lawn was sprayed with the product some time ago (dilution factor, application technique, and time frame were not provided)

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Labrador retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

50

lbs

8. Route(s) of exposure

Oral

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

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
  • General
    • Symptom - Lethargy

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-22591921: The reporter, a veterinarian, called on 05/11/10 to report a patient of his may have been exposed to a pesticide containing the active ingredient Cypermethrin. The caller reports a 1 year 50 pound Labrador retriever presented to him for symptoms described as lethargy vomiting and diarrhea. He did not describe the duration of the symptoms or any treatments that may have been provided. He indicates the animal may have ingested material to which the product was applied. He did not specify the amount of ingestion, when the ingestion took place, or if the product applied was concentrate versus dilute product. He, lastly, did not specify if the exposure had been observed. The caller was informed of the class of the active ingredient (pyrethroid) and advised ingestion of small quantities of product is unlikely to yield symptoms more severe than gastrointestinal irritation. He was further advised to treat symptoms as they arise exposures are treated supportively. The caller revealed on routine call back that the animal had died in the night. He indicated the animal was in ¿¿¿pretty bad shape¿¿¿ when it presented. He indicated the lawn had been sprayed recently and it was unknown whether actual exposure had taken place.


To be determined by Registrant

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

Death

19. Provide supplemental information here

The symptoms, as described, are not consistent with exposure to cypermethrin. No exposure was confirmed in this case.