Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-2398
2. Registrant Information.
Registrant Reference Number: PROSAR case #: 1-40733494
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.
28-MAY-15
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
26-MAY-15
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. 28821
PMRA Submission No.
EPA Registration No.
Product Name: Cruiser Maxx Beans Seed Treatment
- Active Ingredient(s)
- FLUDIOXONIL
- METALAXYL-M (MEFENOXAM)
- THIAMETHOXAM
7. b) Type of formulation.
Application Information
8. Product was applied?
No
9. Application Rate.
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).
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.
Data Subject
2. Demographic information of data subject
Sex: Male
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
4. How long did the symptoms last?
Unknown / Inconnu
5. Was medical treatment provided? Provide details in question 13.
No
6. a) Was the person hospitalized?
No
6. b) For how long?
7. Exposure scenario
Unknown
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? moving treated soybeans with bare hands
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.
Skin
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
>8 hrs <=24 hrs / > 8 h < = 24 h
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.)
1-40733494 - The reporter, a farmer, indicated that he was exposed to soybeans treated with a fungicide and an insecticide containing the active ingredients metalaxyl-m, fludioxonil and thiamethoxam. The reporter stated that two days prior to initial contact with the registrant he was moving treated soybeans with his bare hands and the following day he developed diarrhea and tingling all over. The reporter was advised that dermal contact may result in transient dermal irritation and diarrhea would only be expected if the product had been ingested. On follow-up call, two days later, the reporter indicated that his symptoms had improved. He also stated that he now thought his symptoms were due from exposure to a different, unspecified seed treatment. No additional information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.