Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5537

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15057427

Registrant Name (Full Legal Name no abbreviations): Syngenta Crop Protection 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.

29-JUN-07

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

29-JUN-07

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)

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PMRA Registration No. 28408      PMRA Submission No.       EPA Registration No.

Product Name: Actara 25WG Insecticide

• Active Ingredient(s)
  • THIAMETHOXAM

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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. - Out Home / Rés - à l'ext.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.

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

• Gastrointestinal System
  • Symptom - Stomach pain

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?

Unknown

6. b) For how long?

7. Exposure scenario

Non-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)

None

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

Caller reports that neighboring field was sprayed 1 hr ago. Caller's 29 year old wife was outside for a period of approx 10 min's when product was applied. Wife c/o abdominal cramps and states that the odor of the product is quite strong and heavy in the wind. Assesment: - Significant direct physical exposure to the active ingredient is not evident. Odors associated with applications of this are typically attributed to the inert materials of the formula. - Residual odors that remain after applications of this do not carry significant airborne quantities of the active ingredient that would pose a risk of systemic poisoning to individuals who detect the odor. - Keep the patient away from the source of the fumes. Place the patient in an area with fresh air and adequate ventilation. - Individuals who find the odor strong or unpleasant may develop general irritation symptoms including nausea, headache, and respiratory irritation. These symptoms are typically self-limiting and subside with removal of the odor. If symptoms are persistent or worsening, consult a health care professional. - Seeking fresh air until the fumes have dissipated is recommended. - Please call back with any additional questions or concerns. 07/02/07 Follow-Up Husband calling, stated that his wife was just fine. Her symptoms subsided after about two hours. No treatment was done, no MD seen

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Report is questionable because Actara is a water dispersable granular (WG) which has no odour. In conclusion, it is unknown if tank mix was applied. It is unlikely that Actara WG was the cause of the odour.