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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-4551

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-27490464

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.

20-SEP-11

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

25-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)

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.

Data Subject

2. Demographic information of data subject

Sex: Female

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

3. List all symptoms, using the selections below.

System

  • Skin
    • Symptom - Pruritus
    • Symptom - Irritated skin
  • Nervous and Muscular Systems
    • Symptom - Numbness

4. How long did the symptoms last?

>1 mo and <= 2mos / >1 mois et < = 2mois

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? residing in application area

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.

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.)

1-27490464- The caller reports possible exposure to an insecticide containing the active ingredient lambda-cyhalothrin. The reporter indicated both she and her mother reside in a home that was sprayed with the product by a commercial pest control operator 26 and 40 days prior to her initial contact with the registrant. She indicated neither she nor her mother were in the home while the product was applied but she was unable to described the precise re-entry interval. The caller did not describe a discreet exposure incident but indicated she has experienced pruritis, skin irritation, and dermal numbness since the application to her home. She indicates her mother is also experiencing symptoms less severe than her own but she did not describe those symptoms. The caller had indicated she had been taking an over the counter antihistamine recommended by her pharmacist but had not obtained relief. The caller was advised following known or observed dermal exposure to this product we may observe localized numbing, burning, tingling dermal sensations. But these symptoms are typically self limiting spontaneously resolving within 24-48 hours. The symptoms described would not be expected to persist for as long as one month following application with no known exposure described. She was advised to seek medical assistance. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

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: Female

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

3. List all symptoms, using the selections below.

System

  • General
    • Symptom - Malaise

4. How long did the symptoms last?

>1 mo and <= 2mos / >1 mois et < = 2mois

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? residing in the application area

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.

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.)

1-27490464- The caller reports possible exposure to an insecticide containing the active ingredient lambda-cyhalothrin. The reporter indicated both she and her mother reside in a home that was sprayed with the product by a commercial pest control operator 26 and 40 days prior to her initial contact with the registrant. She indicated neither she nor her mother were in the home while the product was applied but she was unable to described the precise re-entry interval. The caller did not describe a discreet exposure incident but indicated she has experienced pruritis, skin irritation, and dermal numbness since the application to her home. She indicates her mother is also experiencing symptoms less severe than her own but she did not describe those symptoms. The caller had indicated she had been taking an over the counter antihistamine recommended by her pharmacist but had not obtained relief. The caller was advised following known or observed dermal exposure to this product we may observe localized numbing, burning, tingling dermal sensations. But these symptoms are typically self limiting spontaneously resolving within 24-48 hours. The symptoms described would not be expected to persist for as long as one month following application with no known exposure described. She was advised to seek medical assistance. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.