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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2338

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: xx

Country: 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.

17-MAY-13

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: Quadris

  • Active Ingredient(s)
    • AZOXYSTROBIN

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

Product Name: Bravo

  • Active Ingredient(s)
    • CHLOROTHALONIL

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

Product Name: Dithane

  • Active Ingredient(s)
    • MANCOZEB

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

Product Name: Captan

  • Active Ingredient(s)
    • CAPTAN

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

Product Name: Decis

  • Active Ingredient(s)
    • DELTAMETHRIN

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

Product Name: chloropicrin

  • 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).

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

Caller complains of a pesticide odour from a close-by ginseng farm that has been occurring for the past couple months and is ongoing. Caller specifies that the pesticide is chloropicrin (similar to tear gas) and is being applied to the ginseng farm field early in the morning every second day and lasts until 16:00. Farmer confirmed that chloropicrin is not used on established ginseng. List of fungicides applied includes Quadris, Bravo, Dithane, Captan. Dithane tends to have a sulfur-like odour. Decis (insecticide) was also mentioned.

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: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

  • General
    • Symptom - Pain
    • Specify - Pain on his sides

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

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?

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 odour smells like "lavender flowers", but once activated with water, smells like "burnt rubber". Caller is renting a close-by property and suffers from medical conditions due to the odour and is now getting pains on his sides. Caller has rated the odour as an 8/10.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.