Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2701

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16277776

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.

13-JUN-08

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

11-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.       PMRA Submission No.       EPA Registration No. 100-1070

Product Name: Fusilade Dx

• Active Ingredient(s)
  • FLUAZIFOP-P-BUTYL
    • Guarantee/concentration 24.5 %

---

7. b) Type of formulation.

Liquid

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 product was sprayed on or about the evening of 6/10 along with 2 non-company products (Lorox, Rutamil).

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

• Nervous and Muscular Systems
  • Symptom - Headache

• Respiratory System
  • Symptom - Shortness of breath

• Cardiovascular System
  • Symptom - Tachycardia

• General
  • Symptom - Other
  • Specify - Elevated pitch to voice

• Nervous and Muscular Systems
  • Symptom - Muscle spasm
  • Specify - Back Spasms

• General
  • Symptom - Sweating

• Skin
  • Symptom - Hair loss

• Nervous and Muscular Systems
  • Symptom - Muscle weakness

• General
  • Symptom - Other
  • Specify - Cannot work

• Nervous and Muscular Systems
  • Symptom - Other
  • Specify - Slow reflexes

• Respiratory System
  • Symptom - Other
  • Specify - Low O2 saturation

• Nervous and Muscular Systems
  • Symptom - Memory loss
  • Symptom - Disorientation

• Skin
  • Symptom - Paresthesia
  • Specify - Tingling nerves

• Nervous and Muscular Systems
  • Symptom - Collapse

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

1

Day(s) / Jour(s)

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?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

1-16277776: The reporter called on 6/13/08 to report she had been exposed to a product containing the active ingredient Fluazifop-p-butyl two days previously. According to the reporter, the product had been applied all night by a nearby vegetable farmer on 6/10 along with two non-company products (Lorox and Rutamil). She believed she had been exposed through overspray. By the next morning, she had developed an elevated pitch to her voice, shortness of breath, and tachycardia. She had then collapsed and was Medivacd to a hospital, where she had received breathing treatments, epinephrine injections, oxygen and an IV. She had been discharged on prednisone taper for 5 days and an Albuterol inhaler. At the time of the 6/13 call, the reporter complained she still felt disoriented, had a severe headache, and had short term memory loss. She could still smell residue of the products outside. Appointments with physicians including a neurologist were pending. The safety profile of the product was discussed and a recommendation was made to the reporter to continue to work with her physicians as needed. The reporter called on 6/14 to reveal she had developed back spasms which were worsening. A recommendation was made to seek medical attention. A follow-up call on 6/20 revealed the reporter was still experiencing symptoms. These included headaches, sweating profusely, hair loss, plus extreme weakness to the point of not being able to work. She stated she could not longer drive as her reflexes had become so slow. According to the reporter, her pain medication had stopped working and the nerve endings in her back tingled. She had an appointment with a neurologist scheduled for 6/23/08. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

Back spasms are not expected symptoms of inhalation exposure to this product. The symptoms experienced by the caller are not as a result of exposure to this product.