Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-1350

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-40049682

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.

25-MAR-15

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

24-MAR-15

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?

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 - Headache

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Irritated throat

• Nervous and Muscular Systems
  • Symptom - Dizziness

• Gastrointestinal System
  • Symptom - Nausea
  • Symptom - Other
  • Specify - White clumps on throat
  • Symptom - Abdominal distension
  • Specify - flatulence
  • Symptom - Stomach pain

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)

Contact with treated area

Amount of time between application and contact 5.5

Hour(s) / Heure(s)

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?

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

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.)

1-40049682 - The reporter indicated that she had been exposed to a registrant insecticide containing the active ingredient Lambda-cyhalothrin. The reporter stated that a pest control operator applied the product in the group home where she works one day prior to initial contact with the registrant. The reporter entered the application site about 5.5 hours after the product had been applied and she worked in the area for about 5 hours. The application site was not ventilated after product application. When the reporter got home from work she felt tired and the following morning she woke up and her forehead was warm, her throat was sore and she could see little white bumps around her throat. At the time of the initial call the reporter also indicated that she had a headache, she was dizzy, nauseous, her stomach hurt and she had been passing gas. The reporter was advised that inhalation of the fumes may cause transient respiratory irritation and ventilation of the group home was recommended. On follow-up call, one day later, the reporter indicated that her headache had improved a little bit, she was no longer nauseous and her throat irritation had improved but she still felt dizzy and although her headache had improved it was still bothering her. She had gone to her doctor earlier in the day and the doctor recommended rest and increased water consumption. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

The symptoms described are not consistent with exposure to an area treated with the product