Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2359

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-40393971

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.

27-APR-15

5. Location of incident.

Country: CANADA

Prov / State: NOVA SCOTIA

6. Date incident was first observed.

27-APR-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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache

• Respiratory System
  • Symptom - Nasal congestion
  • Symptom - Nose bleed

• Skin
  • Symptom - Tingling skin
  • Symptom - Rash

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

6. a) Was the person hospitalized?

Unknown

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 6

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?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

1-40393971 - The reporter indicated that she, her daughter and her cat had been exposed to a registrant insecticide containing the active ingredient Lambda-cyhalothrin. The reporter stated that the pest control operator applied the product inside her home eight hours prior to initial contact with the registrant. The reporter (Subform II #1) , her (age) year old daughter (Subform II #2) and her 13-year-old, 7 pound cat (Subform III #1) re-entered the application site about 6 hours after application and immediately after re-entry the cat started having trouble breathing and had a rapid heartbeat. The reporter stated that these symptoms lasted approximately 10 hours but afterwards the cat was still lethargic and was not eating. The lack of appetite lasted for about 2 days. Per the reporter her cat had previously been diagnosed with a heart murmur and one week prior to the exposure the cat had a seizure and its back legs stopped working for a day. The reporter also stated that her (age) year old daughter had nose and throat irritation within 20 minutes of re-entry and then two days later her legs were itchy and three days later she vomited one time. The reporter stated that when she was in her home her nose became stuffy; she developed a headache and had a nose bleed. Later, she developed some tingling and a rash in her arm. The reporter did indicate that when she re-entered the home wet spots were still evident on hard surfaces and soft surfaces still felt damp. Typically the product is dry within 6 hours and it may be that the product was over applied. Fresh air was recommended and medical attention was advised for any severe or persistent symptoms. The reporter could not be reached on routine follow-up attempts. No additional 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.

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

• Respiratory System
  • Symptom - Irritated nose

• Gastrointestinal System
  • Symptom - Irritated throat
  • Symptom - Vomiting

• Skin
  • Symptom - Itchy skin

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 6

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?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

1-40393971 - The reporter indicated that she, her daughter and her cat had been exposed to a registrant insecticide containing the active ingredient Lambda-cyhalothrin. The reporter stated that the pest control operator applied the product inside her home eight hours prior to initial contact with the registrant. The reporter (Subform II #1) , her (age) year old daughter (Subform II #2) and her 13-year-old, 7 pound cat (Subform III #1) re-entered the application site about 6 hours after application and immediately after re-entry the cat started having trouble breathing and had a rapid heartbeat. The reporter stated that these symptoms lasted approximately 10 hours but afterwards the cat was still lethargic and was not eating. The lack of appetite lasted for about 2 days. Per the reporter her cat had previously been diagnosed with a heart murmur and one week prior to the exposure the cat had a seizure and its back legs stopped working for a day. The reporter also stated that her (age) year old daughter had nose and throat irritation within 20 minutes of re-entry and then two days later her legs were itchy and three days later she vomited one time. The reporter stated that when she was in her home her nose became stuffy; she developed a headache and had a nose bleed. Later, she developed some tingling and a rash in her arm. The reporter did indicate that when she re-entered the home wet spots were still evident on hard surfaces and soft surfaces still felt damp. Typically the product is dry within 6 hours and it may be that the product was over applied. Fresh air was recommended and medical attention was advised for any severe or persistent symptoms. The reporter could not be reached on routine follow-up attempts. No additional 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

1

5. Sex

Female

6. Age (provide a range if necessary )

13

7. Weight (provide a range if necessary )

7

lbs

8. Route(s) of exposure

Respiratory

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

• Respiratory System
  • Symptom - Difficulty Breathing

• Cardiovascular System
  • Symptom - Tachycardia

• Gastrointestinal System
  • Symptom - Vomiting

• Skin
  • Symptom - Itchy skin

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Loss of appetite

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

1-40393971 - The reporter indicated that she, her daughter and her cat had been exposed to a registrant insecticide containing the active ingredient Lambda-cyhalothrin. The reporter stated that the pest control operator applied the product inside her home eight hours prior to initial contact with the registrant. The reporter (Subform II #1) , her (age) year old daughter (Subform II #2) and her 13-year-old, 7 pound cat (Subform III #1) re-entered the application site about 6 hours after application and immediately after re-entry the cat started having trouble breathing and had a rapid heartbeat. The reporter stated that these symptoms lasted approximately 10 hours but afterwards the cat was still lethargic and was not eating. The lack of appetite lasted for about 2 days. Per the reporter her cat had previously been diagnosed with a heart murmur and one week prior to the exposure the cat had a seizure and its back legs stopped working for a day. The reporter also stated that her (age) year old daughter had nose and throat irritation within 20 minutes of re-entry and then two days later her legs were itchy and three days later she vomited one time. The reporter stated that when she was in her home her nose became stuffy; she developed a headache and had a nose bleed. Later, she developed some tingling and a rash in her arm. The reporter did indicate that when she re-entered the home wet spots were still evident on hard surfaces and soft surfaces still felt damp. Typically the product is dry within 6 hours and it may be that the product was over applied. Fresh air was recommended and medical attention was advised for any severe or persistent symptoms. The reporter could not be reached on routine follow-up attempts. No additional information is available.

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To be determined by Registrant

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

Moderate

19. Provide supplemental information here