Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-6502

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15206407

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.

12-AUG-07

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

12-AUG-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. 24984      PMRA Submission No.       EPA Registration No.

Product Name: Matador 120EC Emulsifiable Concentrate Insecticide

• Active Ingredient(s)
  • CYHALOTHRIN-LAMBDA

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

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?

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Tingling in mouth

4. How long did the symptoms last?

>30 min <=2 hrs / >30 min <=2 h

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

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.

Oral

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 was filling a crop dusting plane with the diluted product 1 hour ago and some of the liquid from the hose splashed onto his tongue, but not his face or lips. He has rinsed his mouth with water and washed his face with soap and water. The tip of his tongue is now tingling. Assessment: Discussed with the caller: - Skin exposure may cause a burning, itching, tingling, or numbness sensation as well as inside the mouth on the tongue or mucous membranes. - Symptoms typically develop soon after the exposure and resolve spontaneously within 24 hours. - Remove contaminated clothing and rinse exposed skin with running water for at least 20 minutes. - Recommend to suck on ice chips or drink cold water. - Consult a health care professional if symptoms persist for more than 24 hours. - Please call back with any additional questions or concerns.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.