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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5941

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15163604

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.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.


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.


PMRA Registration No. 26396      PMRA Submission No.       EPA Registration No.

Product Name: Reglone Desiccant

  • Active Ingredient(s)
    • DIQUAT

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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?


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

3. List all symptoms, using the selections below.


  • Eye
    • Symptom - Irritated eye

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


8. How did exposure occur? (Select all that apply)


9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.




11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

History Caller states his male co-worker got soaked with the diluted product 10-15 min ago. He has removed his clothes and has rinsed his skin off with water, but no soap. Caller is asking what to do? Caller sates that he was "soaked" with diluted product, and experienced dermal, ocular, and possible respiratory exposure. Caller also states that he may have gotten some product in his mouth, although he could not taste anything. Reports that his eyes are burning, but is otherwise asymptomatic. Assessment - Skin exposure may result in irritation and redness, which should gradually subside following irrigation. - Remove contaminated clothing and rinse exposed skin with water for at least 20 minutes. - If skin irritation develops, apply cold compresses or vitamin E/aloe vera containing products. - If symptoms develop and persist or worsen over the next 24 hours, seek medical attention. - Product may irritate the eyes, but is not corrosive or expected to cause corneal burns. -Rinse eyes with tepid tap water for at least 20 minutes. - Do not instill any over-the-counter eye drops into the patient's eyes. - If symptoms persist more than 6 hours or worsen in severity, seek medical attention. - Small ingestions of this product are unlikely to result in adverse health effects other than mild GI upset. - May drink some milk or water. - If nausea, vomiting, or diarrhea develops, replace lost fluids. - If symptoms develop and persist or worsen seek medical attention. - Product may cause respiratory irritation, which should resolve with fresh air. - Seek physician evaluation if any difficulty breathing develops, or if sign.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.