Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-2700
2. Registrant Information.
Registrant Reference Number: Prosar case 1-16242203
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.
05-JUN-08
5. Location of incident.
Country: CANADA
Prov / State: ALBERTA
6. Date incident was first observed.
05-JUN-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)
PMRA Registration No. 24984
PMRA Submission No.
EPA Registration No.
Product Name: Matador 120EC Emulsifiable Concentrate Insecticide
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: Unknown / Inconnu
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
The reporter had been using the product for 2 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: Male
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
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
11. What was the length of exposure?
>24 hrs <=3 days / >24 h <=3 jours
12. Time between exposure and onset of symptoms.
>24 hrs <=3 days / >24 h <=3 jours
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.)
1-16242203: The reporter called on 6/5/08 to report possible dermal exposure to an insecticide containing the active ingredient Lambda-cyhalothrin. He had been using the product for the previous 2 days and had now developed pruritis on his arms (wrist to elbow). According to the reporter, the skin looked normal. The reporter had washed after exposure. The safety profile of the product was discussed in terms of its potential for dermal irritation. A recommendation was made to use over the counter hydrocortisone cream or Vitamin E/Aloe Vera topical preparations, and to seek medical care if the symptoms persisted or worsened. No follow-up information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.