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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-8111

2. Registrant Information.

Registrant Name (Full Legal Name no abbreviations): Cheminova Canada Inc.

Address: 2660 Sherwood Heights Dr., Unit 201

City: Oakville

Prov / State: Ontario

Country: Canada

Postal Code: L6J 7Y8

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: QUEBEC

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. 17983      PMRA Submission No.       EPA Registration No.

Product Name: Zolone Flo

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: unknown

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: Female

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

3. List all symptoms, using the selections below.


  • Skin
    • Symptom - Irritated skin
    • Symptom - Red skin
  • Gastrointestinal System
    • Symptom - Abnormal feces colour
  • General
    • Symptom - Weakness
    • Symptom - Drowsiness
  • Nervous and Muscular Systems
    • Symptom - Confusion
    • Symptom - Dizziness
  • Respiratory System
    • Symptom - Laboured breathing
  • Skin
    • Symptom -
    • Specify - purple spots with white centers
  • General
    • Symptom - Diaphoresis
    • Symptom - Chills
  • Eye
    • Symptom - Blurred vision
    • Symptom - Other
    • Specify - blinking
  • Nervous and Muscular Systems
    • Symptom - Stiffness

4. How long did the symptoms last?

>2 mos and <=6mos />2 mois et <=6mois

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)

Contact with treated area

Amount of time between application and contact 7

Hour(s) / Heure(s)

What was the activity? Attach sprinkler heads and harvest bacterial burn specimens

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?

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

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.)

Symptoms began appearing a few minutes after exposure with sluggishness. A few hours after exposure she felt weak. During the night her skin began feeling irritated. She states that she was at work for two days before she started feeling dizzy, sluggish and her face was pale. She was confused and lost her balance. She believes she inhaled product as a result of rustling the leaves on the trees. She was not hospitalized but had repeated visits to the emergency room and states the symptoms are still persistent as of October 10, 2007.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

She re-entered the treated field before the required 24 hour re-entry interval was over. She was not wearing any personal protective equipment as recommended on the label.