Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-6505

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15203246

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.

10-AUG-07

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

04-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)

---

PMRA Registration No. 24984      PMRA Submission No.       EPA Registration No.

Product Name: Matador 120EC Emulsifiable Concentrate Insecticide

• Active Ingredient(s)
  • CYHALOTHRIN-LAMBDA

---

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).

Unknown Application Details

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

• General
  • Symptom - Malaise
  • Symptom - Joint pain

• Gastrointestinal System
  • Symptom - Nausea

4. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 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

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)

10. Route(s) of exposure.

Respiratory

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 that last Saturday (8/4) the neighbors had the product sprayed on their land. The wind had blown the product the direction of the caller's land. The caller stated that the odor was very irritating. The caller complains of feeling like he had a very bad flu, his bones hurt and he in general did not feel well. His wife and daughter complained of headaches. The caller says that about 2 hours later the odor was gone. Later that day he and his family were feeling better. Everyone is asymptomatic now. Assessment: 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. In regards to the cattle according to the information that we have it is not a developmental or reproductive toxicant

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: Female

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

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache

4. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 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

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)

10. Route(s) of exposure.

Respiratory

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 that last Saturday (8/4) the neighbors had the product sprayed on their land. The wind had blown the product the direction of the caller's land. The caller stated that the odor was very irritating. The caller complains of feeling like he had a very bad flu, his bones hurt and he in general did not feel well. His wife and daughter complained of headaches. The caller says that about 2 hours later the odor was gone. Later that day he and his family were feeling better. Everyone is asymptomatic now. Assessment: 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. In regards to the cattle according to the information that we have it is not a developmental or reproductive toxicant

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: Female

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

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache

4. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 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

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)

10. Route(s) of exposure.

Respiratory

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 that last Saturday (8/4) the neighbors had the product sprayed on their land. The wind had blown the product the direction of the caller's land. The caller stated that the odor was very irritating. The caller complains of feeling like he had a very bad flu, his bones hurt and he in general did not feel well. His wife and daughter complained of headaches. The caller says that about 2 hours later the odor was gone. Later that day he and his family were feeling better. Everyone is asymptomatic now. Assessment: 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. In regards to the cattle according to the information that we have it is not a developmental or reproductive toxicant

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.