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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-3751

2. Registrant Information.

Registrant Reference Number: PLR.Incd.PMRA.080923

Registrant Name (Full Legal Name no abbreviations): Diacon Technologies Ltd.

Address: 135 - 11960 Hammersmith Way

City: Richmond

Prov / State: BC

Country: Canada

Postal Code: V7A 5C9

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

10-SEP-08

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

28-AUG-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. 27136      PMRA Submission No.       EPA Registration No.

Product Name: Mycostat P20

  • Active Ingredient(s)
    • PROPICONAZOLE

PMRA Registration No. 25744      PMRA Submission No.       EPA Registration No.

Product Name: MYCOSTAT Q

  • Active Ingredient(s)
    • DIDECYL DIMETHYL AMMONIUM CHLORIDE

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

8

Other Units: ug/cm2

10. Site pesticide was applied to (select all that apply).

Site: Industrial / Industriel

Préciser le type: Sawmill

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

Spraybox application system.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

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

  • Skin
    • Symptom - Rash

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

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

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Contact with treated area

What was the activity? Pulling freshly treated lumber.

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Long-sleeve shirt

Long pants

Chemical resistant gloves

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

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

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.)

The worker was sent to the doctor, but no medication was prescribed.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Worker's long sleeve shirt was contaminated with the pesticide product and a rash was developed on his arm. He was wearing an apron which did not adequately protect his abdomen and a rash was developed on his torso.