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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-2090

2. Registrant Information.

Registrant Reference Number: A2018-003

Registrant Name (Full Legal Name no abbreviations): Nippon Soda Co., Ltd.

Address: 2-1, 2-Chome Ohtemachi

City: Chiyoda-ku, Tokyo

Country: Japan

Postal Code: 100-8165

3. Select the appropriate subform(s) for the incident.

Scientific Study

4. Date registrant was first informed of the incident.

5. Location of incident.

6. Date incident was first observed.

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.

PMRA Registration No. 27125      PMRA Submission No.       EPA Registration No.

Product Name: ACETAMIPRID TECHNICAL INSECTICIDE

• Active Ingredient(s)
  • ACETAMIPRID

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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 VII: Scientific Study

1. Study Reference

Title Acetamiprid -Honey Bee (Apis mellifera L.) 22 Day Larval Toxicity Test (Repeated Exposure)

Date 23-JAN-18

2. a) Is an extension needed to translate the document?

No

3. Type of incident identified in the study

New health or environmental hazard

4. Describe the incident identified in the study (e.g. study demonstrates an increased risk to non-Hodgkin's Lymphoma after exposure to pesticide X)

Nippon Soda Co., Ltd. Is submitting new information to the PMRA related to acetamiprid technical. This information is not necessarily a new adverse effect of the subject chemical, but is rather new information submitted for the Agency's own review and evaluation because the data meet the Agency's administrative reporting criteria. The data are also provided to support the upcoming re-evaluation of acetamiprid.

5. a) Was the study discontinued before completion?

No

5. b) Provide the reason for discontinuation

6. If the study is ongoing, what is the expected completion date?

For Registrant use only

7. Provide supplemental information here