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Sécurité des produits de consommation

Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2009-0169

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: Prosar 1-16655884

Nom du titulaire (nom légal complet, aucune abbréviation): Syngenta Crop Protection Canada, Inc.

Adresse: 140 Research Lane, Research Park

Ville: Guelph

État: Ontario

Pays: Canada

Code postal /Zip: N1G4Z3

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.

Incident chez l'humain

4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

19-SEP-08

5. Lieu de l'incident.

Pays: CANADA

État: BRITISH COLUMBIA

6. Date de la première observation de l'incident.

18-SEP-08

Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

ARLA No d'homologation 22900      ARLA No de la demande d'homologation       EPA No d'homologation.

Nom du produit: Achieve 40DG, Achieve DG, Venture 25DG, Assure from Dupont

  • Matière active
    • TRALKOXYDIM

7. b) Type de formulation.

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?

Non

9. Dose d'application.

10. Site d'application (choisir tout ce qui s'applique).

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?

Inconnu

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Homme

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

  • Systèmes nerveux et musculaire
    • Symptôme - Mal de tête
  • Système gastro-intestinal
    • Symptôme - Mal de gorge
  • General
    • Symptôme - Faiblesse

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Oui

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Autre

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-16655884: A reporter called on 09/19/2008 to report the exposure of two individuals to a mixture of herbicides. The reporter said that there were 3 "Zenaca" products: Achieve DG, Achieve 40DG and Venture 25DG, and 1 non-Syngenta product identified as Assure Mix from Dupont. According to the reporter, her husband (1st Subform II) and his co-worker (2nd Subform II) are employed at a water hauling company. On 09/18/2008, the herbicides and a non-company product were dumped into an oil burning furnace at the worksite. At some point during the work day on 09/18/2008, her husband developed a headache and a sore throat. His signs resolved after leaving work for the day. On 09/19/2008, her husband returned to work. Once at work on 09/19/2008, his signs recurred in a more severe state and he also developed weakness. The signs persisted on 09/19/2008 after he left work and returned home. According to the reporter, her husband¿¿¿s coworker was experiencing the same signs (details regarding coworkers exposure are unknown). The reporter was advised that individuals who find the odor strong or unpleasant may experience signs including nausea, headache, and respiratory irritation. These signs are generally self-limiting and resolve upon cessation of exposure to the odor. A recommendation was made to ventilate the work area to remove residual odors. The reporter was advised that her husband should seek medical attention if his signs persist. A recommendation was made to contact the manufacturers of the non-company product to obtain the safety information for that product. On follow-up on 09/24/2008, the reporter stated that her husband¿¿¿s sore throat was persistent. He did see his physician and was started on antihistamines which resulted in some improvement. Thoracic radiographs were performed as well (date unknown). At the time of the report, the results of the radiographs were pending and the reporter assumed this meant they were within normal limits. The reporter did not have any information regarding her husband¿¿¿s coworker¿¿¿s signs. NOTE: The reporter reported that ONE company product was mixed with one non-company product. The reporter was reading the company product name from an unknown type of label and listed the ¿¿¿ingredients¿¿¿ in the product which are actually three separate products, two of which are no longer on the market and no longer registered.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

NOTE: There is some confusion regarding what was actually added to the furnace, given the information provided by the reporter. The reporter reported that ONE company product was mixed with one non-company product; however, there were three Syngenta products identified. The reporter was reading the company product names from an unknown type of label and listed the ¿¿¿ingredients¿¿¿ in the product which are actually three separate products, two of which are no longer on the market and no longer registered. There is some doubt as to whether or not these herbicide products are involved since each of them is a solid water dispersible granule. It is doubtful that anyone would try to burn them in an oil burning furnace.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

  • Système gastro-intestinal
    • Symptôme - Mal de gorge
  • Systèmes nerveux et musculaire
    • Symptôme - Mal de tête
  • General
    • Symptôme - Faiblesse

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Inconnu

6. a) Est-ce que la personne a été hospitalisée?

Inconnu

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Autre

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-16655884: A reporter called on 09/19/2008 to report the exposure of two individuals to a mixture of herbicides. The reporter said that there were 3 "Zenaca" products: Achieve DG, Achieve 40DG and Venture 25DG, and 1 non-Syngenta product identified as Assure Mix from Dupont. According to the reporter, her husband (1st Subform II) and his co-worker (2nd Subform II) are employed at a water hauling company. On 09/18/2008, the herbicides and a non-company product were dumped into an oil burning furnace at the worksite. At some point during the work day on 09/18/2008, her husband developed a headache and a sore throat. His signs resolved after leaving work for the day. On 09/19/2008, her husband returned to work. Once at work on 09/19/2008, his signs recurred in a more severe state and he also developed weakness. The signs persisted on 09/19/2008 after he left work and returned home. According to the reporter, her husband¿¿¿s coworker was experiencing the same signs (details regarding coworkers exposure are unknown). The reporter was advised that individuals who find the odor strong or unpleasant may experience signs including nausea, headache, and respiratory irritation. These signs are generally self-limiting and resolve upon cessation of exposure to the odor. A recommendation was made to ventilate the work area to remove residual odors. The reporter was advised that her husband should seek medical attention if his signs persist. A recommendation was made to contact the manufacturers of the non-company product to obtain the safety information for that product. On follow-up on 09/24/2008, the reporter stated that her husband¿¿¿s sore throat was persistent. He did see his physician and was started on antihistamines which resulted in some improvement. Thoracic radiographs were performed as well (date unknown). At the time of the report, the results of the radiographs were pending and the reporter assumed this meant they were within normal limits. The reporter did not have any information regarding her husband¿¿¿s coworker¿¿¿s signs. NOTE: The reporter reported that ONE company product was mixed with one non-company product. The reporter was reading the company product name from an unknown type of label and listed the ¿¿¿ingredients¿¿¿ in the product which are actually three separate products, two of which are no longer on the market and no longer registered.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

NOTE: There is some confusion regarding what was actually added to the furnace, given the information provided by the reporter. The reporter reported that ONE company product was mixed with one non-company product; however, there were three Syngenta products identified. The reporter was reading the company product names from an unknown type of label and listed the ¿¿¿ingredients¿¿¿ in the product which are actually three separate products, two of which are no longer on the market and no longer registered. There is some doubt as to whether or not these herbicide products are involved since each of them is a solid water dispersible granule. It is doubtful that anyone would try to burn them in an oil burning furnace.