Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-0399

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 2022SCPC00062629

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

Domestic Animal

4. Date registrant was first informed of the incident.

07-DEC-22

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

06-DEC-22

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. 27428      PMRA Submission No.       EPA Registration No.

Product Name: DEMAND CS INSECTICIDE

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

---

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: Res. - In Home / Rés. - à l'int. maison

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.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache
  • Symptom - Dizziness

• Respiratory System
  • Symptom - Wheezing
  • Symptom - Irritated nose
  • Symptom - Other
  • Specify - Irritated sinuses

4. How long did the symptoms last?

>30 min <=2 hrs / >30 min <=2 h

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

Non-occupational

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

Contact with treated area

Amount of time between application and contact 7

Hour(s) / Heure(s)

What was the activity? Reporter entered their home after it had been treated

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.

Respiratory

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 h

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.)

2022SCPC00062629- The reporter indicates an exposure to a pesticide containing the active ingredient lambda-cyhalothrin. The day before the day of initial contact with the registrant, the reporter indicated they entered their home seven hours after the product had been applied by a pest control company. Within two hours of exposure the caller developed dizziness, headaches, wheezing and irritation in their nostrils and sinuses. The reporter left the area and the symptoms resolved within two hours. The reporter was advised to thoroughly ventilate the treated area and to seek medical attention should the symptoms persist. No additional information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

14

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Respiratory

9. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Muscle spasm

• Gastrointestinal System
  • Symptom - Vomiting

• Respiratory System
  • Symptom - Choking
  • Specify - Making choking sounds

• Nervous and Muscular Systems
  • Symptom - Restlessness

• General
  • Symptom - Hyperactivity
  • Symptom - Pica

12. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 h

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

Fully Recovered / Complètement rétabli

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

2022SCPC00062629 - The reporter, a pet owner, indicates an exposure to a pesticide containing the active ingredient lambda-cyhalothrin. The day before the day of initial contact with the registrant, the reporter indicated their 14-year-old, female dog of unknown weight and breed entered the reporters home seven hours after the product had been applied by a pest control company. Within two hours of exposure the dog developed muscle spasms and severe vomiting, was making choking sounds, was restless and hyperactive and was trying to eat non-food items. The reporter and the dog left the area and the dogs symptoms resolved within eight hours. The reporter was planning to seek veterinary evaluation of the dog. The reporter was advised to thoroughly ventilate the treated area. No additional information is available.

---

To be determined by Registrant

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

Minor

19. Provide supplemental information here