Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2396

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-40685813

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.

Domestic Animal

4. Date registrant was first informed of the incident.

24-MAY-15

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

23-MAY-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

• 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. - Out Home / Rés - à l'ext.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 III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Mixed breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

13

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Vomiting

• General
  • Symptom - Lethargy

12. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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

Yes

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-40685813 - The reporter, a pet owner, indicated that her dog had been exposed to a registrant insecticide containing the active ingredient Lambda-cyhalothrin. The reporter indicated that the pest control operator applied the product inside her home one day prior to initial contact with the registrant. The reporter and her 1-year-old, male, 13 pound Maltipoo dog re-entered the home 4 hours after application. After the dog entered the home it repeatedly licked the rug, floor and bedding and then that night at 11pm the dog started vomiting. At the time of the initial call the reporter indicated that her dog had vomited a total of 6 times and was lethargic. The reporter was advised that with ingestion transient gastrointestinal irritation is possible but there are numerous possible causes for the described symptoms. Veterinary care was recommended due to the small size of the dog and the number of vomiting episodes. On follow-up call, two days later, the reporter indicated that the dog was taken to the veterinarian where it was given unspecified "gastrointestinal" medications and the symptoms resolved after about 12 hours. 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

Minor

19. Provide supplemental information here