Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-6856

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

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

Human

Environment

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

08-JUL-19

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. 24175      PMRA Submission No.       EPA Registration No.

Product Name: DRAGNET FT EMULSIFIABLE CONCENTRATE INSECTICIDE

• Active Ingredient(s)
  • PERMETHRIN

---

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

1.7

Other Units: L/min

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

Site: Other / Autre

Préciser le type: outdoors near lake/forest

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Inspector reporting on behalf of complainants from file # x. Where were animals/plants found: land and fresh water lake. Resident from x Rd., (city) concerned about application equipment used by mosquito control company to apply Dragnet FT (24175) near x Lake. Complainant allegedly observed cloud of "mist" floating across x Lake from application of Dragnet FT using STIHL SR 450 backpack sprayer near the lake. Application completed every 3 weeks in summer months. Mosquito control company declared the application equipment is used with the following settings for Dragnet: Metering knob setting 3 (1.7-1.25 L/min flow output); throttle on setting 2 (mid velocity). Candidate claims these settings produce a spray; however, six individuals observed clouds of mist drifting as a result of this application. Mosquito Control company declared application is not completed when conditions favour drift.

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.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Sore throat
  • Symptom - Respiratory irritation

4. How long did the symptoms last?

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

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

Unknown

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

Five (5) landscape worker contacted by spray drift (described as a mist by complainant) from application of Dragnet FT using STIHL SR 450 backpack sprayer on x Rd. The individual inspector spoke with from this incident was more concerned with reporting the environmental risks of the application than the risk to their health from the incident (they had some symptoms of exposure ? sore throat, respiratory issues for 1 week).

To be determined by Registrant

14. Severity classification.

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: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Respiratory irritation
  • Symptom - Sore throat

4. How long did the symptoms last?

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

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

Unknown

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

Five (5) landscape worker contacted by spray drift (described as a mist by complainant) from application of Dragnet FT using STIHL SR 450 backpack sprayer on x Rd. The individual inspector spoke with from this incident was more concerned with reporting the environmental risks of the application than the risk to their health from the incident (they had some symptoms of exposure ? sore throat, respiratory issues for 1 week).

To be determined by Registrant

14. Severity classification.

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: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Respiratory irritation
  • Symptom - Sore throat

4. How long did the symptoms last?

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

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

Unknown

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

Five (5) landscape worker contacted by spray drift (described as a mist by complainant) from application of Dragnet FT using STIHL SR 450 backpack sprayer on x Rd. The individual inspector spoke with from this incident was more concerned with reporting the environmental risks of the application than the risk to their health from the incident (they had some symptoms of exposure ? sore throat, respiratory issues for 1 week).

To be determined by Registrant

14. Severity classification.

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: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Respiratory irritation
  • Symptom - Sore throat

4. How long did the symptoms last?

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

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

Unknown

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

Five (5) landscape worker contacted by spray drift (described as a mist by complainant) from application of Dragnet FT using STIHL SR 450 backpack sprayer on x Rd. The individual inspector spoke with from this incident was more concerned with reporting the environmental risks of the application than the risk to their health from the incident (they had some symptoms of exposure ? sore throat, respiratory issues for 1 week).

To be determined by Registrant

14. Severity classification.

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: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Respiratory irritation
  • Symptom - Sore throat

4. How long did the symptoms last?

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

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

Occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

Five (5) landscape worker contacted by spray drift (described as a mist by complainant) from application of Dragnet FT using STIHL SR 450 backpack sprayer on x Rd. The individual inspector spoke with from this incident was more concerned with reporting the environmental risks of the application than the risk to their health from the incident (they had some symptoms of exposure ? sore throat, respiratory issues for 1 week).

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Fish-Non-schooling/Poisson-Autre poisson

2. Common name(s)

Fish

3. Scientific name(s)

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Lake

Terrestrial

Salt Water

6. Check all symptoms that apply

Death

7. Describe symptoms and outcome (died, recovered, etc.).

Complainants noted reduction of wildlife and insect activity in areas of application (birds, small mammals, dragonflies, bees). Concerns about effects of repetitive Dragnet FT (24175) application for mosquito control on forest and lake ecosystem health. Complaint concerned fish kill in x Lake, (city) ON possibly connected to mosquito control applications with Dragnet FT applied using STIHL SR 450 backpack sprayer.

8. a) Was the incident a result of (select all that apply)

Application

Drift

8. b) i) How many times has the product been applied this year?

Unknown

8. b) ii) What was the date of the last application?

Unknown

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

Aquatic

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Unknown

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Terr. Invrtbrt-Honey Bee/Inv.Ter-Abeille

2. Common name(s)

bees

3. Scientific name(s)

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Terrestrial

Forest

Salt Water

6. Check all symptoms that apply

Abnormal behavioural effects

7. Describe symptoms and outcome (died, recovered, etc.).

Complainants noted reduction of wildlife and insect activity in areas of application (birds, small mammals, dragonflies, bees). Concerns about effects of repetitive Dragnet FT (24175) application for mosquito control on forest and lake ecosystem health. Complaint concerned fish kill in x Lake, (city) ON possibly connected to mosquito control applications with Dragnet FT applied using STIHL SR 450 backpack sprayer.

8. a) Was the incident a result of (select all that apply)

Application

Drift

8. b) i) How many times has the product been applied this year?

Unknown

8. b) ii) What was the date of the last application?

Unknown

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

Terrestrial

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Unknown

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Bird - Flocking/Oiseau-Vivant en colonie

2. Common name(s)

birds

3. Scientific name(s)

4. Number of organisms affected

5. Description of site where incident was observed

Fresh water

Terrestrial

Forest

Salt Water

6. Check all symptoms that apply

Abnormal behavioural effects

7. Describe symptoms and outcome (died, recovered, etc.).

Complainants noted reduction of wildlife and insect activity in areas of application (birds, small mammals, dragonflies, bees). Concerns about effects of repetitive Dragnet FT (24175) application for mosquito control on forest and lake ecosystem health. Complaint concerned fish kill in x Lake, (city) ON possibly connected to mosquito control applications with Dragnet FT applied using STIHL SR 450 backpack sprayer.

8. a) Was the incident a result of (select all that apply)

Application

Drift

8. b) i) How many times has the product been applied this year?

Unknown

8. b) ii) What was the date of the last application?

Unknown

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

Terrestrial

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Unknown

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Mammal-Small/Mammifère-De petite taille

2. Common name(s)

small mammals

3. Scientific name(s)

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Terrestrial

Forest

Salt Water

6. Check all symptoms that apply

Abnormal behavioural effects

7. Describe symptoms and outcome (died, recovered, etc.).

Complainants noted reduction of wildlife and insect activity in areas of application (birds, small mammals, dragonflies, bees). Concerns about effects of repetitive Dragnet FT (24175) application for mosquito control on forest and lake ecosystem health. Complaint concerned fish kill in x Lake, (city) ON possibly connected to mosquito control applications with Dragnet FT applied using STIHL SR 450 backpack sprayer.

8. a) Was the incident a result of (select all that apply)

Application

Drift

8. b) i) How many times has the product been applied this year?

Unknown

8. b) ii) What was the date of the last application?

Unknown

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

Terrestrial

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Unknown

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Terr. Invrtbrt-Other/Inv.Ter-Autre

2. Common name(s)

dragonflies

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Terrestrial

Forest

Salt Water

6. Check all symptoms that apply

Abnormal behavioural effects

7. Describe symptoms and outcome (died, recovered, etc.).

Complainants noted reduction of wildlife and insect activity in areas of application (birds, small mammals, dragonflies, bees). Concerns about effects of repetitive Dragnet FT (24175) application for mosquito control on forest and lake ecosystem health. Complaint concerned fish kill in x Lake, (city) ON possibly connected to mosquito control applications with Dragnet FT applied using STIHL SR 450 backpack sprayer.

8. a) Was the incident a result of (select all that apply)

Application

Drift

8. b) i) How many times has the product been applied this year?

Unknown

8. b) ii) What was the date of the last application?

Unknown

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

Terrestrial

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Unknown

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here