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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-6099

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-28046592

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.


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: VIRGINIA

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. 100-1232

Product Name: Demand EZ Insecticide

  • Active Ingredient(s)
      • Guarantee/concentration 2.43 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


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

Site: Res. - Out Home / Rés - à l'

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 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.


  • Nervous and Muscular Systems
    • Symptom - Dizziness
    • Symptom - Ataxia
  • General
    • Symptom - Malaise
  • Respiratory System
    • Symptom - Shortness of breath
  • General
    • Symptom - Fatigue
  • Gastrointestinal System
    • Symptom - Nausea
  • Blood
    • Symptom - Elevated anion gap
    • Specify - elevated anion gap

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?


Day(s) / Jour(s)

7. Exposure scenario


8. How did exposure occur? (Select all that apply)

Contact with treated area

Amount of time between application and contact 2

Day(s) / Jour(s)

What was the activity? lawn care in application area

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


10. Route(s) of exposure.


11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>2 hrs <=8 hrs / > 2 h < = 8 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.)

1-28046592- The reporter, a home owner, indicated potential exposure to an insecticidal product containing the active ingredient lambda-cyhalothrin. The reporter, a (age) year woman, stated the product was applied by a commercial pest control operator to the exterior of her home one month prior to her initial contact with the registrant. She was unable to provide further detail regarding the application. She stated she did not enter the application area for two days at which point she spent time trimming trees in the application area. The reporter indicated the day of application she noted the onset of fatigue, dizziness, difficulty walking, and a drunken feeling. Throughout the subsequent week she was dizzy, nauseated, and tired, but somewhat improved. The caller at that point described entering the application area two days after application to trim trees on her property. She described one day after entering the application area worsening of the dizziness and fatigue that persisted throughout the week. 25 days after the application date she reported she was unable to catch her breath and was so dizzy she had difficulty standing and consequently went to the hospital where she was admitted. She reported gradual improvement while admitted and described being on supplemental oxygen though she was unable to describe any addition treatments or diagnostics done. She did comment the doctors were unable to discover the cause for her symptoms. She reported being discharged six days later, but had found the dizziness and shortness of breath were worsening after her release. She described seeing another physician two days after her discharge from the hospital and was given an inhaler for her respiratory symptoms. The caller was throughout this description unable to describe a discreet exposure incident. The caller was advised the symptoms and time line of her symptoms were inconsistent with toxicity profile of the active ingredient or finished product. She was advised to further consult her doctor in efforts to discover the cause of her discomfort. Follow up was obtained from the reporter one week after her initial report at which point she described visits to an otolaryngologist and neurologist. She indicated she had undergone numerous tests and the only abnormal finding was an elevated anion gap. She indicated she would go back to her primary physician at this point. The caller was again advised that the symptoms and time line were inconsistent with the profile of this active ingredient and the finished product. She was encouraged to work with her doctors. The case was not followed further due the inconsistency. No further information is available.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.