Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5674

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-14960979

Registrant Name (Full Legal Name no abbreviations): Syngenta Crop Protection Canda, 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-JUN-07

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

21-MAY-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: Res. - Out Home / Rés - à l'ext.maison

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: Female

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

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Dizziness
  • Symptom - Muscle pain

4. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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)

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>3 days <=1 wk / >3 jours <=1 sem

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 used product approx 1.5 weeks ago, states she also planted a garden in the same time frame. 1 week post use developed achy muscles and dizziness. States sxs have gradually worsened. Follow-Up information: Caller said that she is doing fine. She said that sxs lasted a couple more days. She spoke with her MD and he was not concerned.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Symptoms described are not typical or expected following routine use. Individuals who find the odor strong or unpleasant may develop general symptoms including nausea, headache and respiratory irritation. These symptoms are typically self-limiting and subside with removal of the odor. Would not expect symptoms described, continue to seek out other causes.