Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-0169

2. Registrant Information.

Registrant Reference Number: Prosar 1-16655884

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.

19-SEP-08

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

18-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. 22900      PMRA Submission No.       EPA Registration No.

Product Name: Achieve 40DG, Achieve DG, Venture 25DG, Assure from Dupont

• Active Ingredient(s)
  • TRALKOXYDIM

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

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

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

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

• Nervous and Muscular Systems
  • Symptom - Headache

• Gastrointestinal System
  • Symptom - Sore throat

• General
  • Symptom - Weakness

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?

No

6. b) For how long?

7. Exposure scenario

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.

Respiratory

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.)

1-16655884: A reporter called on 09/19/2008 to report the exposure of two individuals to a mixture of herbicides. The reporter said that there were 3 "Zenaca" products: Achieve DG, Achieve 40DG and Venture 25DG, and 1 non-Syngenta product identified as Assure Mix from Dupont. According to the reporter, her husband (1st Subform II) and his co-worker (2nd Subform II) are employed at a water hauling company. On 09/18/2008, the herbicides and a non-company product were dumped into an oil burning furnace at the worksite. At some point during the work day on 09/18/2008, her husband developed a headache and a sore throat. His signs resolved after leaving work for the day. On 09/19/2008, her husband returned to work. Once at work on 09/19/2008, his signs recurred in a more severe state and he also developed weakness. The signs persisted on 09/19/2008 after he left work and returned home. According to the reporter, her husband¿¿¿s coworker was experiencing the same signs (details regarding coworkers exposure are unknown). The reporter was advised that individuals who find the odor strong or unpleasant may experience signs including nausea, headache, and respiratory irritation. These signs are generally self-limiting and resolve upon cessation of exposure to the odor. A recommendation was made to ventilate the work area to remove residual odors. The reporter was advised that her husband should seek medical attention if his signs persist. A recommendation was made to contact the manufacturers of the non-company product to obtain the safety information for that product. On follow-up on 09/24/2008, the reporter stated that her husband¿¿¿s sore throat was persistent. He did see his physician and was started on antihistamines which resulted in some improvement. Thoracic radiographs were performed as well (date unknown). At the time of the report, the results of the radiographs were pending and the reporter assumed this meant they were within normal limits. The reporter did not have any information regarding her husband¿¿¿s coworker¿¿¿s signs. NOTE: The reporter reported that ONE company product was mixed with one non-company product. The reporter was reading the company product name from an unknown type of label and listed the ¿¿¿ingredients¿¿¿ in the product which are actually three separate products, two of which are no longer on the market and no longer registered.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

NOTE: There is some confusion regarding what was actually added to the furnace, given the information provided by the reporter. The reporter reported that ONE company product was mixed with one non-company product; however, there were three Syngenta products identified. The reporter was reading the company product names from an unknown type of label and listed the ¿¿¿ingredients¿¿¿ in the product which are actually three separate products, two of which are no longer on the market and no longer registered. There is some doubt as to whether or not these herbicide products are involved since each of them is a solid water dispersible granule. It is doubtful that anyone would try to burn them in an oil burning furnace.

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Sore throat

• Nervous and Muscular Systems
  • Symptom - Headache

• General
  • Symptom - Weakness

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

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.

Respiratory

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.)

1-16655884: A reporter called on 09/19/2008 to report the exposure of two individuals to a mixture of herbicides. The reporter said that there were 3 "Zenaca" products: Achieve DG, Achieve 40DG and Venture 25DG, and 1 non-Syngenta product identified as Assure Mix from Dupont. According to the reporter, her husband (1st Subform II) and his co-worker (2nd Subform II) are employed at a water hauling company. On 09/18/2008, the herbicides and a non-company product were dumped into an oil burning furnace at the worksite. At some point during the work day on 09/18/2008, her husband developed a headache and a sore throat. His signs resolved after leaving work for the day. On 09/19/2008, her husband returned to work. Once at work on 09/19/2008, his signs recurred in a more severe state and he also developed weakness. The signs persisted on 09/19/2008 after he left work and returned home. According to the reporter, her husband¿¿¿s coworker was experiencing the same signs (details regarding coworkers exposure are unknown). The reporter was advised that individuals who find the odor strong or unpleasant may experience signs including nausea, headache, and respiratory irritation. These signs are generally self-limiting and resolve upon cessation of exposure to the odor. A recommendation was made to ventilate the work area to remove residual odors. The reporter was advised that her husband should seek medical attention if his signs persist. A recommendation was made to contact the manufacturers of the non-company product to obtain the safety information for that product. On follow-up on 09/24/2008, the reporter stated that her husband¿¿¿s sore throat was persistent. He did see his physician and was started on antihistamines which resulted in some improvement. Thoracic radiographs were performed as well (date unknown). At the time of the report, the results of the radiographs were pending and the reporter assumed this meant they were within normal limits. The reporter did not have any information regarding her husband¿¿¿s coworker¿¿¿s signs. NOTE: The reporter reported that ONE company product was mixed with one non-company product. The reporter was reading the company product name from an unknown type of label and listed the ¿¿¿ingredients¿¿¿ in the product which are actually three separate products, two of which are no longer on the market and no longer registered.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

NOTE: There is some confusion regarding what was actually added to the furnace, given the information provided by the reporter. The reporter reported that ONE company product was mixed with one non-company product; however, there were three Syngenta products identified. The reporter was reading the company product names from an unknown type of label and listed the ¿¿¿ingredients¿¿¿ in the product which are actually three separate products, two of which are no longer on the market and no longer registered. There is some doubt as to whether or not these herbicide products are involved since each of them is a solid water dispersible granule. It is doubtful that anyone would try to burn them in an oil burning furnace.