Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2021-4210
2. Registrant Information.
Registrant Reference Number: ProPharma Group case #: 2021SCPC00013132
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.
Human
4. Date registrant was first informed of the incident.
02-JUN-21
5. Location of incident.
Country: CANADA
Prov / State: MANITOBA
6. Date incident was first observed.
02-JUN-21
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. 24984
PMRA Submission No.
EPA Registration No. Unknown
Product Name: MATADOR 120EC INSECTICIDE
- Active Ingredient(s)
- LAMBDA-CYHALOTHRIN
- Guarantee/concentration 120 g/L
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: Unknown / Inconnu
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
2021SCPC00013132 - A non-registrant product, Pounce, was applied at the same time as the registrant's product. No additional information is available.
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: Male
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Specify - Migraine with aura
4. How long did the symptoms last?
Unknown / Inconnu
5. Was medical treatment provided? Provide details in question 13.
Unknown
6. a) Was the person hospitalized?
Unknown
6. b) For how long?
7. Exposure scenario
Unknown
8. How did exposure occur? (Select all that apply)
Application
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.)
2021SCPC00013132 - The reporter indicates an exposure to a pesticide containing the active ingredient lambda-cyhalothrin. On the day of initial contact with the registrant, the reporter indicated her husband developed a migraine with aura after applying the product. The reporter was advised to seek medical attention for her husband if the symptom persisted, but it would be unusual for this symptom to occur from the described exposure to the pesticide. No additional information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.