Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-3651
2. Registrant Information.
Registrant Reference Number: PROSAR case #: 1-41371386
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-JUL-15
5. Location of incident.
Country: CANADA
Prov / State: NOVA SCOTIA
6. Date incident was first observed.
17-JUL-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)
PMRA Registration No. 31300
PMRA Submission No.
EPA Registration No.
Product Name: Masterline Lambdacy Insecticide
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).
The pest control operator sprayed the product in an overhead wasp's nest.
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
Other
2. Type of animal affected
Dog / Chien
3. Breed
Unknown
4. Number of animals affected
3
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
20
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
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?
Accidental ingestion/Ingestion accident.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-41371386 - The reporter, a pest control operator, indicated that three dogs were exposed to a registrant insecticide containing the active ingredient Lambda-cyhalothrin. The reporter sprayed an overhead wasps nest at a customers house seven days prior to initial contact with the registrant. Three days prior to initial contact, the reporter returned to the customers home, knocked the nest down and stepped on it. That same day the pet owner saw one of her three dogs eat part of the nest. Either the day before or the day the nest was knocked down all three of the dogs developed bloody stool. The dogs have been to the veterinarian and are on some unknown medication. The reporter was advised that ingestion of the product may cause transient gastrointestinal upset but bloody stool is not consistent with the described exposure. No additional information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here