Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-0008

2. Registrant Information.

Registrant Reference Number: Prosar 1-16390555

Registrant Name (Full Legal Name no abbreviations): United Agri Products Canada, Inc.

Address: 789 Donnybrook Drive

City: Dorchester

Prov / State: Ontario

Country: Canada

Postal Code: N0L1G5

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

Human

4. Date registrant was first informed of the incident.

11-JUL-08

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

20-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)

---

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

Product Name: Unknown Malathion-Based Insecticide

• Active Ingredient(s)
  • MALATHION

---

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: Res. - Out Home / Rés - à l'ext.maison

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

The product was applied by a neighbor in an unknown concentration for three weeks prior to the initial report. The exact product name and manufacturer is unknown.

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.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Diarrhea
  • Symptom - Stomach cramps

• Respiratory System
  • Symptom - Shortness of breath

4. How long did the symptoms last?

Unknown / Inconnu

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

Non-occupational

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

Drift from the application site

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

Respiratory

11. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

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.)

1-16390555: A reporter called on 07/11/2008 to report the exposure of herself and her husband to an insecticide containing the active ingredient Malathion. According to the reporter, her neighbor had been spraying the product in an unknown concentration for the 3 weeks prior to the report. The reporter (Ist Subform II) stated that the product has "been taking her breath away" in addition to causing her to have diarrhea and cramps for the past 3 weeks. The reporter also stated that her husband (2nd Subform II) has been having diarrhea, cramps, and occasional tremors for the past 3 weeks. The reporter asked the neighbor what the product was on 07/11/2008 after he accidentally sprayed her with it from the waist down. The reporter was provided the active ingredient name. The reporter obtained the company's name after searching the active ingredient, but she is not sure that the product the neighbor is using is a company product. The reporter wants to know who to call to get her neighbor to stop spraying the product. The reporter was advised that with overexposure to the concentrated active ingredient or chronic exposure to the identified active ingredient, serious signs may occur, including gastrointestinal, respiratory, and neurologic signs. A recommendation was made for the caller to remove her clothing and shower for at least 20 minutes to remove the product from her skin. Another recommendation was made for the reporter and her husband to see their health care provider and inform him/her about their exposure to Malathion. The reporter was advised to call the Department of Public Health or local police if her neighbor continues to spray the product onto their property. The reporter called back on 07/14/2008. She reported that she and her husband did see their health care provider (unknown date). Both the reporter and her husband were feeling better at the time of the follow up report, but the diarrhea persisted. Neither the reporter nor her husband were given any medications for their signs. Their health care provider advised them to let the signs run their course. The reporter stated that she called the Health Department but was told that there are no regulations regarding the product. She also stated that she thinks the neighbor is not diluting the product properly. The reporter stated that other neighbors (3rd Subform II)have had diarrhea as well (unknown details of signs and exposure). The reporter was advised to drink plenty of water to maintain hydration. A recommendation was made to discuss her and her husband's persistent signs with their health care provider. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Diarrhea
  • Symptom - Stomach cramps

• Nervous and Muscular Systems
  • Symptom - Muscle tremors

4. How long did the symptoms last?

Unknown / Inconnu

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

Non-occupational

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

Drift from the application site

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.

Respiratory

11. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

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.)

1-16390555: A reporter called on 07/11/2008 to report the exposure of herself and her husband to an insecticide containing the active ingredient Malathion. According to the reporter, her neighbor had been spraying the product in an unknown concentration for the 3 weeks prior to the report. The reporter (Ist Subform II) stated that the product has "been taking her breath away" in addition to causing her to have diarrhea and cramps for the past 3 weeks. The reporter also stated that her husband (2nd Subform II) has been having diarrhea, cramps, and occasional tremors for the past 3 weeks. The reporter asked the neighbor what the product was on 07/11/2008 after he accidentally sprayed her with it from the waist down. The reporter was provided the active ingredient name. The reporter obtained the company's name after searching the active ingredient, but she is not sure that the product the neighbor is using is a company product. The reporter wants to know who to call to get her neighbor to stop spraying the product. The reporter was advised that with overexposure to the concentrated active ingredient or chronic exposure to the identified active ingredient, serious signs may occur, including gastrointestinal, respiratory, and neurologic signs. A recommendation was made for the caller to remove her clothing and shower for at least 20 minutes to remove the product from her skin. Another recommendation was made for the reporter and her husband to see their health care provider and inform him/her about their exposure to Malathion. The reporter was advised to call the Department of Public Health or local police if her neighbor continues to spray the product onto their property. The reporter called back on 07/14/2008. She reported that she and her husband did see their health care provider (unknown date). Both the reporter and her husband were feeling better at the time of the follow up report, but the diarrhea persisted. Neither the reporter nor her husband were given any medications for their signs. Their health care provider advised them to let the signs run their course. The reporter stated that she called the Health Department but was told that there are no regulations regarding the product. She also stated that she thinks the neighbor is not diluting the product properly. The reporter stated that other neighbors (3rd Subform II)have had diarrhea as well (unknown details of signs and exposure). The reporter was advised to drink plenty of water to maintain hydration. A recommendation was made to discuss her and her husband's persistent signs with their health care provider. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

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

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Diarrhea

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

Non-occupational

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

Other

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.)

1-16390555: A reporter called on 07/11/2008 to report the exposure of herself and her husband to an insecticide containing the active ingredient Malathion. According to the reporter, her neighbor had been spraying the product in an unknown concentration for the 3 weeks prior to the report. The reporter (Ist Subform II) stated that the product has "been taking her breath away" in addition to causing her to have diarrhea and cramps for the past 3 weeks. The reporter also stated that her husband (2nd Subform II) has been having diarrhea, cramps, and occasional tremors for the past 3 weeks. The reporter asked the neighbor what the product was on 07/11/2008 after he accidentally sprayed her with it from the waist down. The reporter was provided the active ingredient name. The reporter obtained the company's name after searching the active ingredient, but she is not sure that the product the neighbor is using is a company product. The reporter wants to know who to call to get her neighbor to stop spraying the product. The reporter was advised that with overexposure to the concentrated active ingredient or chronic exposure to the identified active ingredient, serious signs may occur, including gastrointestinal, respiratory, and neurologic signs. A recommendation was made for the caller to remove her clothing and shower for at least 20 minutes to remove the product from her skin. Another recommendation was made for the reporter and her husband to see their health care provider and inform him/her about their exposure to Malathion. The reporter was advised to call the Department of Public Health or local police if her neighbor continues to spray the product onto their property. The reporter called back on 07/14/2008. She reported that she and her husband did see their health care provider (unknown date). Both the reporter and her husband were feeling better at the time of the follow up report, but the diarrhea persisted. Neither the reporter nor her husband were given any medications for their signs. Their health care provider advised them to let the signs run their course. The reporter stated that she called the Health Department but was told that there are no regulations regarding the product. She also stated that she thinks the neighbor is not diluting the product properly. The reporter stated that other neighbors (3rd Subform II)have had diarrhea as well (unknown details of signs and exposure). The reporter was advised to drink plenty of water to maintain hydration. A recommendation was made to discuss her and her husband's persistent signs with their health care provider. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.