Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5539

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15068447

Registrant Name (Full Legal Name no abbreviations): Syngenta Crop Protection 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.

03-JUL-07

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

03-JUL-07

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)

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PMRA Registration No. 19346      PMRA Submission No.       EPA Registration No.

Product Name: Tilt 250E Fungicide

• Active Ingredient(s)
  • PROPICONAZOLE

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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

Préciser le type: Unknown

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: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Loss of coordination

• Ear
  • Symptom - Ringing in ear

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?

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?

>15 min <=2 hrs / >15 min <=2 h

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.)

Caller states this product was sprayed on the wrong field/farm. His neighboring farmer was spraying crops on 7/3/07 approx 7-9pm while he was outdoors on his farm. Was exposed to overspray for approx 30 minutes, 12 hours ago. When caller woke this am developed ringing in his ears, "head in a fog", incoordinated and not very alert. Caller states he does not have a HCP because he is a believer in God's power of healing and relies on his god to help him, not physicians. Assessment: After reviewing the products in our database these Tilt products may cause irritation. Exposure to high vapor levels may cause headache, dizziness, numbness, nausea, in-coordination, or other central nervous system effects. Due to symptoms described my recommendation is a consult with HCP. I understand your position however my recommendation still stands.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

A follow-up call was made and indicated that the person exposed is fine and there are no lasting effects.