Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-4615

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-31633963

Registrant Name (Full Legal Name no abbreviations): Syngenta 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.

Domestic Animal

4. Date registrant was first informed of the incident.

26-SEP-12

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

Unknown

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. 100-1066

Product Name: Demand CS

• 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. - Out Home / Rés - à l'ext.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 III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Yorkshire Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

6

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Respiratory System
  • Symptom - Sneezing
  • Symptom - Nasal congestion
  • Symptom - Runny nose

12. How long did the symptoms last?

Unknown / Inconnu

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

Yes

14. a) Was the animal hospitalized?

No

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

1-31633963 - The reporter, a pet owner, indicated that her dog was exposed to an insecticidal product containing the active ingredient Lambda-cyhalothrin. The pet owner reported that a pest control operator applied the product to her gazebo two months prior to initial contact with the registrant. After the product was applied the reporter kept her 7-year-old, male, Yorkshire terrier out of the application site for over three hours. The pet owner indicated that sometime after her dog re-entered the application area her dog has been sneezing and he suffers from nasal congestion and a runny nose. These symptoms are only present in the mornings and were still present at the time of initial contact. The reporter has brought her dog to the veterinarian who thought the dog was suffering from allergies. The reporter was advised that inhalation of the wet product during application may cause transient respiratory irritation but the described symptoms would not be expected. The reporter was further advised to seek veterinary care if symptoms worsen. No further information is available.

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To be determined by Registrant

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

Minor

19. Provide supplemental information here