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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3465

2. Registrant Information.

Registrant Reference Number: PROSAR Case #:1-22938921

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.


5. Location of incident.


Prov / State: CALIFORNIA

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1218

Product Name: Demon MAX

  • Active Ingredient(s)
      • Guarantee/concentration 25.3 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.

10. Site pesticide was applied to (select all that apply).

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed


4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )


8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms


  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-229389921-The reporter, a veterinarian, calls to indicate possible exposure of three patients to an insecticide containing the active ingredient Cypermethrin. The reporter indicates three patients of his have died recently. The animals were all dogs. One animal was a Shih-Tzu; the others unspecified breed, weight or age. He did indicate all may have died of "old age" and had numerous concurrent medical conditions (unspecified). The caller did not indicate any signs that may have preceded the deaths, any care that might have been given, or diagnostics that may have been offered. He was unable to specify when two of the animals had died (he indicated "the last while"), but did indicate the Shih-Tzu dog had died 05-28-10. No necropsy was performed. The caller stated no exposure was observed but the pet's owner had stated a pest control operator had applied the product in her home in the recent past (unspecified date, unspecified application technique). The caller was informed the product carried a wide margin of safety and a low level of toxicity. Ingestions of small quantities of this product are unlikely to result in significant problems but if enough is ingested minor GI upset may result. No systemic effects including the deaths described would be expected under normal use circumstances. No further information is available.

To be determined by Registrant

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


19. Provide supplemental information here

Initial contact was by a vet who was merely conducting due diligence. It is highly unlikely that the pesticide was involved in the death of these animals. There was no evidence of direct exposure and no symptoms which could be related to cypermethrin.