Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-5191

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-41478482

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.

04-AUG-15

5. Location of incident.

Country: UNITED STATES

Prov / State: OREGON

6. Date incident was first observed.

28-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)

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

Product Name: Demand CS

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

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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. - 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 reporter, an owner of a PCO company, indicated that his technician applied the registrant product and a non-registrant product, called Talstar P and L at a customer's house. The demand CS was diluted to a concentration of 0.015% and applied on the eaves and the foundation of the house. The Talstar P and L was applied on the lawn. Caller believes that there was a buffer zone around the pond but he does not know the distance of the buffer zone.

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

Fish / Poisson

3. Breed

Koi

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

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

1-41478482 - The reporter, a pest control operator, indicated that an unknown number of koi were exposed to an insecticide containing the active ingredient Lambda-cyhalothrin and to a non-registrant insecticide named Talstar with the active ingredient bifenthrin. Seven days prior to initial contact with the registrant the reporters technician applied the diluted registrant product (diluted to 0.015%) on the eaves and foundation of a customers home and the Talstar was applied to the customers lawn. The reporter believes his technician did not apply the Talstar to the edge of the customers small pond but he is not sure what buffer zone was used. On the day of initial contact the customer informed the reporter that she had found one of her koi dead in the pond that morning and the other koi seemed lethargic. The reporter stated that they had not had any rain since application of the products, he was not sure if the customer had watered her yard. He did indicate that they had just gotten over a 3-4 day heat spell with temperatures above 100F. The reporter was advised that per package labeling exposure to fish should be avoided. The reporter was further advised that there are numerous possible causes for fish death; high ambient temperatures with fish in a small pond can be a concern. No further information is available.

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To be determined by Registrant

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

Death

19. Provide supplemental information here