Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-1359

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-36836981

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

Domestic Animal

4. Date registrant was first informed of the incident.

22-APR-14

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

20-APR-14

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.

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 - Irritated skin

• Eye
  • Symptom - Irritated eye

• General
  • Symptom - Taste altered
  • Specify - Unpleasant taste

• Respiratory System
  • Symptom - Other
  • Specify - pink nasal secretions
  • Symptom - Other
  • Specify - Nasal irritation

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

Amount of time between application and contact 2

Day(s) / Jour(s)

What was the activity? Daily living

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.)

1-36836981 - The reporter indicated that her cats and she were exposed to a pesticide containing the active ingredient lambda-cyhalothrin. The reporter stated that a pest control operator applied this product in her apartment four days prior to initial contact with the registrant. The pest control operator did not follow labeled directions during application and sprayed the reporters mattress, couch, etc. After application the reporter and her 4 cats left the apartment for a period of 4 days. At the time of the report the reporter and her cats have been home for a period of 48 hours and they all have symptoms. Caller states that she has burning skin, sore eyes and can taste the product on her lips and her tongue. All four of the reporters 1.5 year old cats are sneezing, rubbing at their eyes and have watery eyes. In addition, one of the reporters female cats did not eat the evening prior to the report and vomited on the morning of the report. The reporter indicates that this cat did eat after it vomited in the morning. The reporter was advised that per package labeling the product is not meant to be applied on soft furniture. Ventilation of the apartment was recommended as well as bathing and washing of surfaces to remove the residue. On follow-up, one day later, the reporter indicated that she has been cleaning her apartment but is now experiencing nasal irritation and she has some pink nasal discharge. Ventilation was recommended while cleaning to prevent nasal irritation from any cleaning products. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Unknown

4. Number of animals affected

3

5. Sex

Unknown

6. Age (provide a range if necessary )

1.5

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Respiratory

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Skin
  • Symptom - Irritated skin

• Eye
  • Symptom - Irritated eye
  • Symptom - Discharge eye

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

Unknown

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

1-36836981 - The reporter indicated that her cats and she were exposed to a pesticide containing the active ingredient lambda-cyhalothrin. The reporter stated that a pest control operator applied this product in her apartment four days prior to initial contact with the registrant. The pest control operator did not follow labeled directions during application and sprayed the reporter¿¿¿¿¿¿s mattress, couch, etc. After application the reporter and her 4 cats left the apartment for a period of 4 days. At the time of the report the reporter and her cats have been home for a period of 48 hours and they all have symptoms. Caller states that she has burning skin, sore eyes and can taste the product on her lips and her tongue. All four of the reporter¿¿¿¿¿¿s 1.5 year old cats are sneezing, rubbing at their eyes and have watery eyes. In addition, one of the reporters female cats did not eat the evening prior to the report and vomited on the morning of the report. The reporter indicates that this cat did eat after it vomited in the morning. The reporter was advised that per package labeling the product is not meant to be applied on soft furniture. Ventilation of the apartment was recommended as well as bathing and washing of surfaces to remove the residue. On follow-up, one day later, the reporter indicated that she has been cleaning her apartment but is now experiencing nasal irritation and she has some pink nasal discharge. Ventilation was recommended while cleaning to prevent nasal irritation from any cleaning products. 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

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1.5

7. Weight (provide a range if necessary )

9

lbs

8. Route(s) of exposure

Skin

Respiratory

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Eye
  • Symptom - Discharge eye
  • Symptom - Irritated eye

• Respiratory System
  • Symptom - Sneezing

• Gastrointestinal System
  • Symptom - Anorexia
  • Symptom - Vomiting

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

Unknown

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

1-36836981 - The reporter indicated that her cats and she were exposed to a pesticide containing the active ingredient lambda-cyhalothrin. The reporter stated that a pest control operator applied this product in her apartment four days prior to initial contact with the registrant. The pest control operator did not follow labeled directions during application and sprayed the reporter¿¿¿¿¿¿s mattress, couch, etc. After application the reporter and her 4 cats left the apartment for a period of 4 days. At the time of the report the reporter and her cats have been home for a period of 48 hours and they all have symptoms. Caller states that she has burning skin, sore eyes and can taste the product on her lips and her tongue. All four of the reporter¿¿¿¿¿¿s 1.5 year old cats are sneezing, rubbing at their eyes and have watery eyes. In addition, one of the reporters female cats did not eat the evening prior to the report and vomited on the morning of the report. The reporter indicates that this cat did eat after it vomited in the morning. The reporter was advised that per package labeling the product is not meant to be applied on soft furniture. Ventilation of the apartment was recommended as well as bathing and washing of surfaces to remove the residue. On follow-up, one day later, the reporter indicated that she has been cleaning her apartment but is now experiencing nasal irritation and she has some pink nasal discharge. Ventilation was recommended while cleaning to prevent nasal irritation from any cleaning products. 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