Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-2003

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 2024SCPC00078349

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.

04-APR-24

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

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.

Active(s)

---

PMRA Registration No. 27428      PMRA Submission No.       EPA Registration No.

Product Name: DEMAND CS INSECTICIDE

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

---

PMRA Registration No. 32524      PMRA Submission No.       EPA Registration No.

Product Name: TEMPRID SC

• Active Ingredient(s)
  • BETA-CYFLUTHRIN
  • IMIDACLOPRID

---

PMRA Registration No. 30075      PMRA Submission No.       EPA Registration No.

Product Name: BEDLAM® INSECTICIDE

• Active Ingredient(s)
  • D-PHENOTHRIN
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE

---

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).

The area had also been treated with the non-registrant products TEMPRID SC (PMRA Registration No. 32524) and BEDLAM INSECTICIDE (PMRA Registration No. 30075).

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: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Reproductive System
  • Symptom - Other
  • Specify - Vaginal bleeding
  • Symptom - Other
  • Specify - Ovarian issues
  • Symptom - Other
  • Specify - Uterine masses

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?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Contact with treated area

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

>1 yr / > 1 an

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.)

2024SCPC00078349- The reporter, a family member of the patient, indicates an exposure to a pesticide containing the active ingredient lambda-cyhalothrin. During the fifteen months preceding the day of initial contact with the registrant, the reporter indicated the interior of the patientas residence had been sprayed at least five times with the product. The patient experienced vaginal bleeding for over two months as well as ovarian issues and masses on their uterus. The patient is under the care of a physician but has not been hospitalized. The reporter was advised that the symptoms were not consistent with exposure to this pesticide as described and the patient should continue to receive symptomatic and supportive medical attention. No additional information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.