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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-1535

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-36930366

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.

5. Location of incident.

Country: UNITED STATES

Prov / State: PENNSYLVANIA

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.

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1066

Product Name: Demand CS

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN
    • Guarantee/concentration 9.7 %

7. b) Type of formulation.

Liquid

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

• Nervous and Muscular Systems
  • Symptom - Numbness
  • Specify - Numbness in mouth and lip

• Gastrointestinal System
  • Symptom - Other
  • Specify - Dental injury
  • Symptom - Other
  • Specify - Weight gain

• General
  • Symptom - Chemical taste in mouth
  • Specify - Unpleasant taste

• Gastrointestinal System
  • Symptom - Other
  • Specify - Difficulty prehending food

• General
  • Symptom - Other
  • Specify - Masses in ears

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

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)

Application

Other

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.

Skin

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.)

1-36930366 - The reporter indicates that she was exposed to an insecticide containing the active ingredient Lambda-cyhalothrin. The reporter states that 5.5 years prior to initial contact with the company, while in someone elses home, a PCO accidentally saturated the reporter with an insecticide. At the time of the incident the reporter was told by the PCO that the product was called Demand CS. Caller does not have any additional product information and is recalling the name from memory. After the exposure the reporter noted a bad chemical taste in her mouth and her lower lip was numb. Per the reporter the first 2 years after the exposure were the worst the only thing that helped with the persistent bad taste was drinking Coca-Cola and eating sugar products. The reporter gained 25 pounds in a short amount of time. The reporter also indicates that she broke her teeth because she could not feel them. The reporter states that she still cannot feel any pressure in her lower lip and she drops food, especially green beans, while eating. Recently she developed a mass in one ear and then the other ear. She has not yet had the masses biopsied. The reporter has seen numerous doctors including a neurologist, an ENT and a psychologist. The reporter was advised that the described symptoms are not consistent with exposure to the product. Continued medical care was recommended to help determine an underlying cause and appropriate treatment. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.