Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2695

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16159644

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.

18-MAY-08

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

15-MAY-08

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. 27192      PMRA Submission No.       EPA Registration No.

Product Name: Touchdown iQ Liquid Herbicide

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS MONO-AMMONIUM SALT OR DIAMMONIUM SALT)

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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: Other / Autre

Préciser le type: Unknown where applied

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

The reporter sprayed the product 3 days prior to the call.

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

• Gastrointestinal System
  • Symptom - Diarrhea
  • Symptom - Nausea

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Unknown

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.

Skin

Oral

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

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

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.)

1-16159644: The reporter called on 5/18/08 to report she had been exposed to a product containing the active ingredient Glyphosate 3 days prior to the call. According to the reporter, she got a little product on her skin and in her mouth while spraying. She had developed nausea and diarrhea 3 hours after the exposure. As of the time of the call, the symptoms had persisted. The safety profile of the product was discussed. A recommendation was made to seek medical care as the symptoms had persisted. A follow-up call was placed but was never returned.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.