Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2841

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16312904

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.

22-JUN-08

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

22-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. 25448      PMRA Submission No.       EPA Registration No.

Product Name: Gramoxone PDQ

• Active Ingredient(s)
  • DIQUAT
  • PARAQUAT

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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).

A hose broke while the product was being applied on 6/22/08. It had been diluted at 30 parts water to 1 part product. Note: The registration for this product has expired.

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.

Medical Professional

2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Blurred vision
  • Symptom - Irritated eye

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?

Unknown

6. b) For how long?

7. Exposure scenario

Occupational

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.

Eye

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 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.)

1-16312904: The reporter, an RN, called on 6/22/08 to report that a male patient had had an ocular exposure event to a product containing the active ingredient Paraquat 1 hour previously. According to the reporter, a hose had broken during application and some diluted product (diluted at 30 parts water to 1 part product) had sprayed into the patient¿s eye. Per the caller, the patient had experienced blurred vision and ocular irritation after the exposure. Emergency responders had already irrigated the patient¿s eye with 5 liters of normal saline. By the time of the call the patient¿s symptoms had resolved or were dissipating. A follow-up call was placed the next day but contact with the RN could not be re-established. Note: The registration for this product has expired.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

The registration of this product has expired.