Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-4488

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-27198977

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.

19-AUG-11

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

17-AUG-11

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. 27428      PMRA Submission No.       EPA Registration No.

Product Name: Demand CS Insecticide

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

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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. - 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?

No

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

• Skin
  • Symptom - Paresthesia
  • Symptom - Rash

4. How long did the symptoms last?

Unknown / Inconnu

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)

Contact with treated area

What was the activity? re-entry of primary residence (application site)

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Skin

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

1-27198977- The reporter indicated exposure of her family to an insecticide containing the active ingredient lambda-cyhalothrin. The reporter stated a pest control operator had applied the product to the interior of her home two days prior to her initial contact with the registrant. The caller did not have label information such as the PCP number that might assist in identification of the precise formulation used. She stated she had concerns that the pest control operator had not accurately followed label instructions. She stated both she and her family were present during application and she knows of respiratory and dermal exposure to herself and her husband. She reports the product was diluted, as she observed the pest control operator dilute it, but was unaware of the dilution factor used. She reports she also observed the product applied to her child's toys. The caller's main motive to contact the registrant was to discuss label instructions and appropriate household clean up procedures. She was not eager to discuss the exposure. The caller reported she never developed symptoms following her personal exposure and had followed appropriate decontamination procedures. She did indicate her husband (Subform II, #1) had developed a rash and tingling on his feet following walking through a still wet application area with bare feet. She also stated her small child (Subform II, #2) had experiencing a burning sensation on his face after playing with a toy that had product applied to it and then touching his face. The caller indicated all exposed individuals had appropriately washed and all symptoms had spontaneously abated. The caller was advised of proper decontamination procedures and care for symptoms seen should they recur. She was advised rash would not be expected following exposure to this product and may require consultation with a doctor to discover the cause should it recur or worsen. The caller was connected with technical staff that could discuss the labeling of the product and household clean up procedures. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Label directions are clear and PCO ignored label directions.

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: >1 <=6 yrs / > 1 < = 6 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Burning skin

4. How long did the symptoms last?

Unknown / Inconnu

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)

Contact with treated area

What was the activity? re-entry of primary residence (application area)

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

1-27198977- The reporter indicated exposure of her family to an insecticide containing the active ingredient lambda-cyhalothrin. The reporter stated a pest control operator had applied the product to the interior of her home two days prior to her initial contact with the registrant. The caller did not have label information such as the PCP number that might assist in identification of the precise formulation used. She stated she had concerns that the pest control operator had not accurately followed label instructions. She stated both she and her family were present during application and she knows of respiratory and dermal exposure to herself and her husband. She reports the product was diluted, as she observed the pest control operator dilute it, but was unaware of the dilution factor used. She reports she also observed the product applied to her child's toys. The caller's main motive to contact the registrant was discus label instructions and appropriate household clean up procedures. She was not eager to discuss the exposure. The caller reported she never developed symptoms following her personal exposure and had followed appropriate decontamination procedures. She did indicate her husband (Subform II, #1) had developed a rash and tingling on his feet following walking through a still wet application area with bare feet. She also stated her small child (Subform II, #2) had experiencing a burning sensation on his face after playing with a toy that had product applied to it and then touching his face. The caller indicated all exposed individuals had appropriately washed and all symptoms had spontaneously abated. The caller was advised of proper decontamination procedures and care for symptoms seen should they recur. She was advised rash would not be expected following exposure to this product and may require consultation with a doctor to discover the cause should it recur or worsen. The caller was connected with technical staff that could discuss the labeling of the product and household clean up procedures. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.