Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4103

2. Registrant Information.

Registrant Reference Number: Prosar 1-16644304

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.

16-SEP-08

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

09-SEP-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. 26396      PMRA Submission No.       EPA Registration No.

Product Name: Reglone Liquid Herbicide/Desiccant

• Active Ingredient(s)
  • DIQUAT

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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).

The diluted product (50/50 mixture) was being run through a handler when the exposure occurred. The exposure was one week prior to the report.

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 - Taste altered
  • Specify - Tastes the product in his mouth

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

Oral

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

1-16644304: A reporter called on 09/16/2008 to report his father's exposure to an herbicide and dessicant containing the active ingredient Diquat Dibromide. According to the reporter, his father was running the diluted (50:50 mixture) product through a handler one week prior to the report. His father turned the wrong valve and the diluted product was dispensed into his face and mouth. His father washed his face and rinsed his mouth immediately after the exposure. The reporter does not know whether his father swallowed any of the product. His father did taste the product in his mouth for 3-4 days, but the reporter was not sure if this was persistent at the time of the report. His father did not develop any other symptoms. The reporter was advised to have his father call to report the incident and the current status of his symptoms. An attempt at follow up was unsuccessful and no further information was obtained.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.