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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-5812
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-24662165
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
Domestic Animal
4. Date registrant was first informed of the incident.
09-NOV-105. Location of incident.
Country: CANADA
Prov / State: QUEBEC
6. Date incident was first observed.
09-NOV-10Product 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. 27428 PMRA Submission No. EPA Registration No.
Product Name: Demand CS Insecticide
- Active Ingredient(s)
- LAMBDA-CYHALOTHRIN
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. - In Home / Rés. - à l'int. maison
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?
Unknown
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Male
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Respiratory System
- Symptom - Coughing
4. How long did the symptoms last?
Unknown / Inconnu
5. Was medical treatment provided? Provide details in question 13.
Unknown
6. a) Was the person hospitalized?
Unknown
6. b) For how long?
7. Exposure scenario
Non-occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
Amount of time between application and contact 6
Hour(s) / Heure(s)
What was the activity? re-entry of a residential home (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.
Unknown
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
>8 hrs <=24 hrs / > 8 h < = 24 h
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.)
1-24662165- The reporter, a pest control operator, indicated potential exposure to two home owners and their pet to an insecticide containing the active ingredient lambda cyhalothrin. The reporter indicates he applied the product diluted (unspecified rate) to a homes kitchen twenty four hours prior to his initial contact with the registrant. The reporter indicated he had informed the home owner to re-entry should be six hours following application and they should ventilate thoroughly prior to re-entry. It is unknown if the home owner observed the instructions provided. The pest control operator reported he had been contacted by the male home owner (Subform II, #1) to state he, his wife (Subform II, #2), and their dog (Subform III, #1) had all developed a cough twenty four hours following application. They report a detectable aroma; no specific exposure incident was described. The reporter was advised of potential non-specific symptoms of respiratory irritation that can occur when individuals perceive the aroma of herbicides/pesticides. The reporter was advised of clean up that may mitigate aromas, and that sensitive individuals may require symptomatic care. No toxicity would be expected. The reporter was unable to be reached despite attempts for routine follow up. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Female
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Respiratory System
- Symptom - Coughing
4. How long did the symptoms last?
Unknown / Inconnu
5. Was medical treatment provided? Provide details in question 13.
Unknown
6. a) Was the person hospitalized?
Unknown
6. b) For how long?
7. Exposure scenario
Non-occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
Amount of time between application and contact 6
Hour(s) / Heure(s)
What was the activity? Re-entry of a residential home (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.
Unknown
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
>8 hrs <=24 hrs / > 8 h < = 24 h
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.)
1-24662165- The reporter, a pest control operator, indicated potential exposure to two home owners and their pet to an insecticide containing the active ingredient lambda cyhalothrin. The reporter indicates he applied the product diluted (unspecified rate) to a homes kitchen twenty four hours prior to his initial contact with the registrant. The reporter indicated he had informed the home owner to re-entry should be six hours following application and they should ventilate thoroughly prior to re-entry. It is unknown if the home owner observed the instructions provided. The pest control operator reported he had been contacted by the male home owner (Subform II, #1) to state he, his wife (Subform II, #2), and their dog (Subform III, #1) had all developed a cough twenty four hours following application. They report a detectable aroma; no specific exposure incident was described. The reporter was advised of potential non-specific symptoms of respiratory irritation that can occur when individuals perceive the aroma of herbicides/pesticides. The reporter was advised of clean up that may mitigate aromas, and that sensitive individuals may require symptomatic care. No toxicity would be expected. The reporter was unable to be reached despite attempts for routine follow up. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
unknown
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
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Respiratory System
- Symptom - Coughing
12. How long did the symptoms last?
Unknown / Inconnu
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
Unknown/Inconnu
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
1-24662165- The reporter, a pest control operator, indicated potential exposure to two home owners and their pet to an insecticide containing the active ingredient lambda cyhalothrin. The reporter indicates he applied the product diluted (unspecified rate) to a homes kitchen twenty four hours prior to his initial contact with the registrant. The reporter indicated he had informed the home owner to re-entry should be six hours following application and they should ventilate thoroughly prior to re-entry. It is unknown if the home owner observed the instructions provided. The pest control operator reported he had been contacted by the male home owner (Subform II, #1) to state he, his wife (Subform II, #2), and their dog (Subform III, #1) had all developed a cough twenty four hours following application. They report a detectable aroma; no specific exposure incident was described. The reporter was advised of potential non-specific symptoms of respiratory irritation that can occur when individuals perceive the aroma of herbicides/pesticides. The reporter was advised of clean up that may mitigate aromas, and that sensitive individuals may require symptomatic care. No toxicity would be expected. The reporter was unable to be reached despite attempts for routine follow up. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
