Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4112

2. Registrant Information.

Registrant Reference Number: Prosar 1-16646133

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.

17-SEP-08

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

17-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 product was being applied on 09/16/2008 when the exposure occurred. It is unclear where (residential, agricultural, etc) the product was being used.

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

• Eye
  • Symptom - Irritated eye
  • Symptom - Red eye
  • Symptom - Pain
  • Symptom - Swollen eye
  • Symptom - Discharge eye
  • Specify - ocular discharge
  • Symptom - Foreign body sensation in eye
  • Specify - "bumpy inside eyelid"

• Respiratory System
  • Symptom - Runny nose

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

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.

Eye

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

>8 hrs <=24 hrs / > 8 h < = 24 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.)

1-16646133: A reporter called on 09/17/2008 to report the exposure of her husband to an herbicide and dessicant containing the active ingredient Diquat Dibromide. According to the reporter, her husband was using the product on 09/16/2008 when he accidentally got some of it in his eye. He immediately rinsed his eye with water from a water bottle and the garden hose. He showered 2.5 hours later and flushed his eyes out again. He also used unspecified eye drops at some point on 09/16/2008. On 09/17/2008, her husband developed nasal discharge and ocular discharge, redness, and swelling. The reporter requested the Material Safety Data Sheet (MSDS) for the product. The reporter was advised that ocular exposure to the product may result in significant irritation and prolonged (weeks) impairment of vision. The degree of injury depends upon the amount of material that gets into the eye and how quickly and thoroughly the eye is irrigated. Symptoms after ocular exposure include pain, tearing, swelling, redness, and blurred vision. A recommendation was made to consult an ophthalmologist as antibiotics and/or anti-inflammatories may be indicated. Another reporter (attending physician) called on 09/17/2008 to inquire about treatment recommendations for the patient. The physician was advised of the potential for ocular exposure to result in significant ocular irritation and impairment of vision. Symptoms and factors determining the degree of injury were also reviewed with the physician. A recommendation was made to treat the affected eye with ophthalmic antibiotics to prevent secondary infection and use a steroid ophthalmic preparation if needed as an anti-inflammatory. The physician was also advised that while corneal abrasions are not expected as a result of product exposure, the patient's corneas should be evaluated. On follow up on 09/18/2008, the initial reporter stated that her husband's eye had become more swollen and irritated despite treatment. The reporter was advised that her husband should follow his physician's instructions and consider re-evaluation if no improvement is noted. On follow up on 09/22/2008, the initial reporter stated that her husband's eye is still red, "bumpy" on the inner surface of the eyelid and "drains" consistently. He also complains of a burning sensation when he uses the ophthalmic solution. The reporter stated that her husband is waiting for a referral to an ophthalmologist and requested that the toxicologist at Health and Safety provide a referral for her husband. The reporter was advised that the toxicologist is unable to provide a referral. A recommendation was made for her husband to follow up with his primary physician to obtain a referral to an ophthalmologist since the signs are persistent. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.