Print | Need Larger Text?

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-1726

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 2022SCPU00042385

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.

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

Unknown

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.       PMRA Submission No.       EPA Registration No. 100-1295

Product Name: LAMCAP II

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN
    • Guarantee/concentration 22.8 %

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 II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Medical Professional

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Diarrhea

• Liver
  • Symptom - Elevated liver enzymes

• Blood
  • Symptom - Other
  • Specify - Electrolyte disturbances
  • Symptom - Other
  • Specify - Elevated creatine kinase

• Nervous and Muscular Systems
  • Symptom - Agitation

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Unknown

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

Poisoning from ingestion of the pesticide

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.

Oral

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.)

2022SCPU00042385- The reporter, a health care professional, indicates an exposure to a pesticide containing the active ingredient lambda-cyhalothrin. An unknown amount of time before the day of initial contact with the registrant, the reporter stated the patient ingested an unknown amount of the concentrated pesticide and subsequently developed diarrhea, electrolyte disturbances, elevated liver enzymes, and elevated creatine kinase an unknown amount of time later. The reporter indicated the patient was sedated and intubated on intake to the health care facility because the patient was altered from several substances in his system but did not provide additional information on the substances.. On follow-up call one day later, the reporter indicated the patient¿¿¿¿¿¿s diarrhea was resolving and the abnormal electrolytes, liver enzymes and creatine kinase values were tending towards normal. On follow-up call two days after the day of initial contact, the reporter indicated they had attempted to extubate the patient, but he became agitated. On follow-up call four days after the day of initial contact, the reporter indicated the patient had been extubated, but was still agitated. On follow-up call five days after the day of initial contact, the reporter indicated the patient was no longer agitated, was still experiencing diarrhea and electrolyte disturbances, and was discharged from the intensive care unit to the main medical floor. On follow-up call five days after the day of initial contact, the reporter was not available. On follow-up call six days after the day of initial contact, the reporter indicated the patient had been discharged. No additional information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.