Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5663

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-14975237

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.

06-JUN-07

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

02-JUN-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. 28642      PMRA Submission No.       EPA Registration No.

Product Name: Axial 100EC Herbicide

• Active Ingredient(s)
  • PINOXADEN

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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 Crop

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

Applied over 9000 acres

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

• Respiratory System
  • Symptom - Coughing

• Gastrointestinal System
  • Symptom - Sore throat

• General
  • Symptom - Hoarseness
  • Specify - Raspy Voice

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

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.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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 is (work position) for Syngenta. Caller reports that a grower has used product for 3 to 4 days, applied over 9000 acres. Caller states that 3 individuals were exposed to product during application, and now complain of the following symptoms: Raspy voice, sore throat, cough Additional information: Incident took place in [LOCATION]

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Following-up with caller June 29/07, caller commented that after he had thought about it, he "realized" there had been a virus going around at the time of the complaints and even he and some of his office staff (he also has a separate business) who had no Axial exposure had experienced similar symptoms. He then continued to say that he was sorry that he had reported the incident because he is now convinced it was virus-related. Caller politely made it clear that there was not need for Syngenta to investigate the incident further, that everyone was fine, and his workers' symptoms subsided a few days after spraying was completed.

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

• Respiratory System
  • Symptom - Coughing

• Gastrointestinal System
  • Symptom - Sore throat

• General
  • Symptom - Hoarseness
  • Specify - Raspy Voice

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

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.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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 is (work position) for Syngenta. Caller reports that a grower has used product for 3 to 4 days, applied over 9000 acres. Caller states that 3 individuals were exposed to product during application, and now complain of the following symptoms: Raspy voice, sore throat, cough Additional information: Incident took place in [LOCATION].

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

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: >12 <=19 yrs / >12 <=19 ans

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing

• Gastrointestinal System
  • Symptom - Sore throat

• General
  • Symptom - Hoarseness
  • Specify - Raspy Voice

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

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.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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 is (work position) for Syngenta. Caller reports that a grower has used product for 3 to 4 days, applied over 9000 acres. Caller states that 3 individuals were exposed to product during application, and now complain of the following symptoms: Raspy voice, sore throat, cough Additional information: Incident took place in [LOCATION].

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.