Health Canada
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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-2012

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: SASKATCHEWAN

6. Date incident was first observed.

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.       PMRA Submission No.       EPA Registration No.

Product Name: unknown

  • Active Ingredient(s)
    • 2,4-D (PRESENT AS ACID)
    • GLYPHOSATE

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

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Manager of workers that were exposed to spray drift. Suspect it was a tank mix with 2,4-d, glyphosate and maybe a growth regulator such as heat. The pesticide exposure was from spray drift into our orchard and the farmer who was spraying would not give me the chemicals he was using when I called him to discuss this matter. The direction of the wind SSE with wind gusts up to 67 km/h. Our orchard is straight north of the field being sprayed. John Deer high clearance sprayer.

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

  • Nervous and Muscular Systems
    • Symptom - Headache
  • Gastrointestinal System
    • Symptom - Nausea
  • Eye
    • Symptom - Red 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?

Unknown

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)

Unknown

10. Route(s) of exposure.

Unknown

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.)

The 6 workers experienced head aches and nausea which was treated was treated by providing tylenol that evening. 2 of the workers experienced redness in there eyes that lasted 2 days. The 6 people were exposed as a result of the spray drift coming into the orchard they were working in. Our workers are from Nicaragua so they were not aware that they could leave the orchard or take action. (Shame on me as a Canadian farm manager as I should have told them). They continued to work throughout the day in these conditions and only told me about how they were feeling that evening. The farmer (first and last name), had one of his employees spraying his field which is directly south of our 160 acre orchard. Our workers were in the block directly across the road from where the farmer was spraying. When they told me about the incident they said the smell was very bad, caused headaches and a nauseous feeling. They reported actually feeling a mist on their faces when working. They said the wind was very strong. I did call the farmer who owns the field and asked why he would be spraying on such a windy day. I also asked him if he could give me a list of the chemicals used in his tank mix. He did not after several calls to him and told me that any further communication would be through registered mail (whatever that means). I told him that I thought he had a responsibility to provide the chemicals used and that I was definitely going to do a lab analysis to determine the chemicals present. In addition to the fact that he continued to spray even in the presence of my workers his actions caused significant damage in our orchards because our trees were at 100% blossom.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

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

  • Nervous and Muscular Systems
    • Symptom - Headache
  • Gastrointestinal System
    • Symptom - Nausea
  • Eye
    • Symptom - Red 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?

Unknown

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)

Unknown

10. Route(s) of exposure.

Unknown

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.)

The 6 workers experienced head aches and nausea which was treated was treated by providing tylenol that evening. 2 of the workers experienced redness in there eyes that lasted 2 days. The 6 people were exposed as a result of the spray drift coming into the orchard they were working in. Our workers are from Nicaragua so they were not aware that they could leave the orchard or take action. (Shame on me as a Canadian farm manager as I should have told them). They continued to work throughout the day in these conditions and only told me about how they were feeling that evening. The farmer (first and last name), had one of his employees spraying his field which is directly south of our 160 acre orchard. Our workers were in the block directly across the road from where the farmer was spraying. When they told me about the incident they said the smell was very bad, caused headaches and a nauseous feeling. They reported actually feeling a mist on their faces when working. They said the wind was very strong. I did call the farmer who owns the field and asked why he would be spraying on such a windy day. I also asked him if he could give me a list of the chemicals used in his tank mix. He did not after several calls to him and told me that any further communication would be through registered mail (whatever that means). I told him that I thought he had a responsibility to provide the chemicals used and that I was definitely going to do a lab analysis to determine the chemicals present. In addition to the fact that he continued to spray even in the presence of my workers his actions caused significant damage in our orchards because our trees were at 100% blossom.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

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

  • Nervous and Muscular Systems
    • Symptom - Headache
  • Gastrointestinal System
    • Symptom - Nausea

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?

Unknown

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)

Unknown

10. Route(s) of exposure.

Unknown

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.)

The 6 workers experienced head aches and nausea which was treated was treated by providing tylenol that evening. 2 of the workers experienced redness in there eyes that lasted 2 days. The 6 people were exposed as a result of the spray drift coming into the orchard they were working in. Our workers are from Nicaragua so they were not aware that they could leave the orchard or take action. (Shame on me as a Canadian farm manager as I should have told them). They continued to work throughout the day in these conditions and only told me about how they were feeling that evening. The farmer (first and last name), had one of his employees spraying his field which is directly south of our 160 acre orchard. Our workers were in the block directly across the road from where the farmer was spraying. When they told me about the incident they said the smell was very bad, caused headaches and a nauseous feeling. They reported actually feeling a mist on their faces when working. They said the wind was very strong. I did call the farmer who owns the field and asked why he would be spraying on such a windy day. I also asked him if he could give me a list of the chemicals used in his tank mix. He did not after several calls to him and told me that any further communication would be through registered mail (whatever that means). I told him that I thought he had a responsibility to provide the chemicals used and that I was definitely going to do a lab analysis to determine the chemicals present. In addition to the fact that he continued to spray even in the presence of my workers his actions caused significant damage in our orchards because our trees were at 100% blossom.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

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

  • Nervous and Muscular Systems
    • Symptom - Headache
  • Gastrointestinal System
    • Symptom - Nausea

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?

Unknown

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)

Unknown

10. Route(s) of exposure.

Unknown

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.)

The 6 workers experienced head aches and nausea which was treated was treated by providing tylenol that evening. 2 of the workers experienced redness in there eyes that lasted 2 days. The 6 people were exposed as a result of the spray drift coming into the orchard they were working in. Our workers are from Nicaragua so they were not aware that they could leave the orchard or take action. (Shame on me as a Canadian farm manager as I should have told them). They continued to work throughout the day in these conditions and only told me about how they were feeling that evening. The farmer (first and last name), had one of his employees spraying his field which is directly south of our 160 acre orchard. Our workers were in the block directly across the road from where the farmer was spraying. When they told me about the incident they said the smell was very bad, caused headaches and a nauseous feeling. They reported actually feeling a mist on their faces when working. They said the wind was very strong. I did call the farmer who owns the field and asked why he would be spraying on such a windy day. I also asked him if he could give me a list of the chemicals used in his tank mix. He did not after several calls to him and told me that any further communication would be through registered mail (whatever that means). I told him that I thought he had a responsibility to provide the chemicals used and that I was definitely going to do a lab analysis to determine the chemicals present. In addition to the fact that he continued to spray even in the presence of my workers his actions caused significant damage in our orchards because our trees were at 100% blossom.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

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

  • Gastrointestinal System
    • Symptom - Nausea
  • Nervous and Muscular Systems
    • Symptom - Headache

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?

Unknown

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)

Unknown

10. Route(s) of exposure.

Unknown

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.)

The 6 workers experienced head aches and nausea which was treated was treated by providing tylenol that evening. 2 of the workers experienced redness in there eyes that lasted 2 days. The 6 people were exposed as a result of the spray drift coming into the orchard they were working in. Our workers are from Nicaragua so they were not aware that they could leave the orchard or take action. (Shame on me as a Canadian farm manager as I should have told them). They continued to work throughout the day in these conditions and only told me about how they were feeling that evening. The farmer (first and last name), had one of his employees spraying his field which is directly south of our 160 acre orchard. Our workers were in the block directly across the road from where the farmer was spraying. When they told me about the incident they said the smell was very bad, caused headaches and a nauseous feeling. They reported actually feeling a mist on their faces when working. They said the wind was very strong. I did call the farmer who owns the field and asked why he would be spraying on such a windy day. I also asked him if he could give me a list of the chemicals used in his tank mix. He did not after several calls to him and told me that any further communication would be through registered mail (whatever that means). I told him that I thought he had a responsibility to provide the chemicals used and that I was definitely going to do a lab analysis to determine the chemicals present. In addition to the fact that he continued to spray even in the presence of my workers his actions caused significant damage in our orchards because our trees were at 100% blossom.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

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

  • Gastrointestinal System
    • Symptom - Nausea
  • Nervous and Muscular Systems
    • Symptom - Headache

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?

Unknown

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)

Unknown

10. Route(s) of exposure.

Unknown

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.)

The 6 workers experienced head aches and nausea which was treated was treated by providing tylenol that evening. 2 of the workers experienced redness in there eyes that lasted 2 days. The 6 people were exposed as a result of the spray drift coming into the orchard they were working in. Our workers are from Nicaragua so they were not aware that they could leave the orchard or take action. (Shame on me as a Canadian farm manager as I should have told them). They continued to work throughout the day in these conditions and only told me about how they were feeling that evening. The farmer (first and last name), had one of his employees spraying his field which is directly south of our 160 acre orchard. Our workers were in the block directly across the road from where the farmer was spraying. When they told me about the incident they said the smell was very bad, caused headaches and a nauseous feeling. They reported actually feeling a mist on their faces when working. They said the wind was very strong. I did call the farmer who owns the field and asked why he would be spraying on such a windy day. I also asked him if he could give me a list of the chemicals used in his tank mix. He did not after several calls to him and told me that any further communication would be through registered mail (whatever that means). I told him that I thought he had a responsibility to provide the chemicals used and that I was definitely going to do a lab analysis to determine the chemicals present. In addition to the fact that he continued to spray even in the presence of my workers his actions caused significant damage in our orchards because our trees were at 100% blossom.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.