Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2703

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16232648

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.

04-JUN-08

5. Location of incident.

Country: CANADA

Prov / State: UNKNOWN

6. Date incident was first observed.

03-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)

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PMRA Registration No. 27833      PMRA Submission No.       EPA Registration No.

Product Name: Callisto 480SC Herbicide

• Active Ingredient(s)
  • MESOTRIONE

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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: Unknown / Inconnu

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?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

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

• Gastrointestinal System
  • Symptom - Vomiting
  • 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.

Unknown

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.)

1-16232648: The reporter, an operator from a poison center, called the registrant on 6/4/08 to inquire about an herbicide containing the active ingredient Mesotrione. According to the reporter, a male patient had been using the product the previous morning (6/3), and by the afternoon of that day had begun to feel ill. He complained of nausea and vomiting, and was still not feeling well the morning of the call. Per the reporter, the patient was wondering about the safety profile of the product ¿ specifically dermal or inhalation exposure. The patient had already taken a shower and was being examined at a physician¿s office. The safety profile of the product as a potential irritant was discussed. First aid information for skin irritation was offered. No follow-up information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

The symptoms described above are not indicative of exposure to this product.