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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2013-2889
2. Registrant Information.
Registrant Reference Number: x
Registrant Name (Full Legal Name no abbreviations): x
Address: x
City: x
Prov / State: x
Country: x
Postal Code: X
3. Select the appropriate subform(s) for the incident.
Human
4. Date registrant was first informed of the incident.
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
05-MAY-13Product 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. 28715 PMRA Submission No. EPA Registration No.
Product Name: PIC PLUS FUMIGANT
- Active Ingredient(s)
- CHLOROPICRIN
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: Agricultural-Outdoor/Agricole-extérieur
Préciser le type: Tobacco - preplant soil treatment
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
There are only two growers in the incident area, at least one is fumigating also tobacco. He has several fields that are currently being fumigated in the area. Distributor thought that the OPP had reported a smell, not eye irritation. 2,4-D had been sprayed that evening and thought they might be smelling that in that area. Landlord cultivated the headlands at the site later on the same day that fumigant was applied. Grower assures that will not this again for at least several days after fumigant application.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: Unknown
Age: Unknown / Inconnu
3. List all symptoms, using the selections below.
System
- Eye
- Symptom - Irritated eye
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
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.
Eye
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.)
Person may have been exposed while driving down the road. There are numerous fields in the area that appear to be treated with soil fumigant (parallel ridges formed in field) in preparation for planting tobacco. Some of the fields have conventional ridges and some have 'high hills', indicating there are at least 2 separate tabacco growers in the area. The 2 tobacco growers in the area use high hills or conventional hills. Observed that the headlands on the conventional hilled fields have been cultivated which will flatten the end of the ridges. If this cultivation was performed shortly after application of soil fumigant (i.e.within 48 hrs) it may cause some fumigant vapour release.
