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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-6759

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-58803511

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.

01-NOV-19

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

Unknown

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. 32606      PMRA Submission No.       EPA Registration No. Unknown

Product Name: GUARDSMAN DIQUAT

  • Active Ingredient(s)
    • DIQUAT

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: Unknown / Inconnu

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: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

  • Skin
    • Symptom - Irritated skin
    • Symptom - Pruritus

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Yes

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)

Application

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.

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.)

1-58803511 - The reporter, a distributor, indicates an exposure to a pesticide containing the active ingredient diquat. On the day of initial contact with the registrant, the reporter indicated he had learned via email of an exposure to a grower two week previous. The reporter indicated a drop of the concentrated product splashed into the skin above the grower's left eye. The reporter indicated the grower immediately wiped off the product but was unable to wash until an unknown amount of time later. At the time of initial contact, the grower had developed skin irritation and pruritis in the area, sought medical attention and was prescribed an antibiotic. On follow-up call one day after the day of initial contact, the grower indicated the affected area was healing. The grower was advised to continue to work with his doctor to resolve the symptom, but a systemic toxicity would not be expected. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.