Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2267

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-32574010

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.

Human

4. Date registrant was first informed of the incident.

28-JAN-13

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

18-JAN-13

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?

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: Female

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Vomiting

4. How long did the symptoms last?

<=30 min / <=30 min

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

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.

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.)

1-32574010 - The reporter indicated that she, her baby and her husband were exposed to an insecticidal product containing the active ingredient Lambda-cyhalothrin. The reporter, an adult female (Subform II #2) indicated that the product was sprayed in her apartment by an exterminator eight days prior to initial contact with the registrant. The reporter indicated that the product was applied throughout her apartment soaking the furniture and the carpet. The reporter (Subform II #2), her husband (Subform II #3) and her (age) month old daughter (Subform II #1) re-entered the apartment in the evening of the day that the product had been applied and both her and her husband developed an irritated throat and eyes and her 18 month old baby vomited one time. The family then left and stayed in a hotel that night and all symptoms quickly resolved after leaving the apartment. The reporter was advised that based on her description the product had been applied to heavily. The reporter was further advised that inhalation of the product may cause transient respiratory irritation but symptoms would not be expected after the area had been ventilated. 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.

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

• Respiratory System
  • Symptom - Itchy throat

• Eye
  • Symptom - Irritated eye

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

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.

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.)

1-32574010 - The reporter indicated that she, her baby and her husband were exposed to an insecticidal product containing the active ingredient Lambda-cyhalothrin. The reporter, an adult female (Subform II #2) indicated that the product was sprayed in her apartment by an exterminator eight days prior to initial contact with the registrant. The reporter indicated that the product was applied throughout her apartment soaking the furniture and the carpet. The reporter (Subform II #2), her husband (Subform II #3) and her (age) month old daughter (Subform II #1) re-entered the apartment in the evening of the day that the product had been applied and both her and her husband developed an irritated throat and eyes and her 18 month old baby vomited one time. The family then left and stayed in a hotel that night and all symptoms quickly resolved after leaving the apartment. The reporter was advised that based on her description the product had been applied to heavily. The reporter was further advised that inhalation of the product may cause transient respiratory irritation but symptoms would not be expected after the area had been ventilated. 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.

Data Subject

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 - Itchy throat

• Eye
  • Symptom - Irritated eye

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

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.

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.)

1-32574010 - The reporter indicated that she, her baby and her husband were exposed to an insecticidal product containing the active ingredient Lambda-cyhalothrin. The reporter, an adult female (Subform II #2) indicated that the product was sprayed in her apartment by an exterminator eight days prior to initial contact with the registrant. The reporter indicated that the product was applied throughout her apartment soaking the furniture and the carpet. The reporter (Subform II #2), her husband (Subform II #3) and her (age) month old daughter (Subform II #1) re-entered the apartment in the evening of the day that the product had been applied and both her and her husband developed an irritated throat and eyes and her 18 month old baby vomited one time. The family then left and stayed in a hotel that night and all symptoms quickly resolved after leaving the apartment. The reporter was advised that based on her description the product had been applied to heavily. The reporter was further advised that inhalation of the product may cause transient respiratory irritation but symptoms would not be expected after the area had been ventilated. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.