Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2544

2. Registrant Information.

Registrant Reference Number: Prosar 1-18819858

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.

13-JUN-09

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

04-JUN-09

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. 100-1091

Product Name: Reward Landscape And Aquatic Herbicide

• Active Ingredient(s)
  • DIQUAT
    • Guarantee/concentration 37.3 %

---

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Pub. Area - Outdoor/Zone publique - ext

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

A public pond was treated with the product. It is unknown what concentration was used and when the product was applied.

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: Female

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Itchy skin

• Eye
  • Symptom - Swollen eye

• General
  • Symptom - Swelling
  • Specify - "Lips swollen",Swollen arm

• Respiratory System
  • Symptom - Difficulty Breathing

• Nervous and Muscular Systems
  • Symptom - Dizziness

• Skin
  • Symptom - Hives

• Eye
  • Symptom - Other
  • Specify - "Hives in eyes"

• Nervous and Muscular Systems
  • Symptom - Ataxia

• Eye
  • Symptom - Other
  • Specify - "Eyelids would not shut"

• General
  • Symptom - Weakness
  • Symptom - Taste altered
  • Specify - "Mouth feels like it is filled with cotton"

• Cardiovascular System
  • Symptom - Fainting
  • Specify - "Passed out"

• Gastrointestinal System
  • Symptom - Nausea
  • Symptom - Diarrhea

• Eye
  • Symptom - Burning eye
  • Symptom - Itchy eye
  • Symptom - Irritated eye
  • Symptom - Red eye

• Respiratory System
  • Symptom - Other
  • Specify - "Lungs feel like they are the size of an apple"

• Renal System
  • Symptom - Other
  • Specify - "Urine temperature felt hot-higher than body temperature"

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Fatigue

• Gastrointestinal System
  • Symptom - Weight loss

• Eye
  • Symptom - Burn on the eye
  • Specify - "Chemical burn"
  • Symptom - Other
  • Specify - "Blew out a cataract"

• Renal System
  • Symptom - Anuria
  • Symptom - Other
  • Specify - "Urinary tract infection, swollen kidney"

• Gastrointestinal System
  • Symptom - Irritated throat

• Nervous and Muscular Systems
  • Symptom - Anxiety

• Eye
  • Symptom - Conjunctivitis

• Skin
  • Symptom - Burning skin

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?

Yes

6. b) For how long?

1

Day(s) / Jour(s)

7. Exposure scenario

Occupational

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

Contact with treated area

What was the activity? weeding the treated pond

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

Eye

11. What was the length of exposure?

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

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 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.)

1-18819858: A reporter (poison control operator) called on 06/13/2009 to report the exposure of a female to an herbicide containing the active ingredient Diquat. According to the reporter, the female patient had been weeding in a treated pond on 06/06 and developed a number of signs (described in communication with patient) after dermal and ocular exposure. The patient was seen at the emergency room the night of the exposure and has further follow up medical appointments scheduled. On follow up with the patient, complete details regarding the exposure, symptoms, and treatment were obtained. On 06/06, the patient was weeding a public pond that had been treated with the product on an unknown date. The patient was working in the treated area for 2.5 hours and was wearing non-specific gloves and a hat. She may have had abrasions near her elbow. The treated water splashed all over the front of the patient and she rubbed her eye with a water contaminated hand. After weeding the pond, she developed arm swelling and burning, itchiness, and a swollen eye. She showered and used an ice pack on her eyes. About 14 hours after product exposure, she woke up with difficulty breathing, dizziness, hives, and eyes swollen shut. She was taken to the emergency room and treated with IV medication, Benadryl injections, and a respiratory treatment. She was discharged with Medrol and antihistamines. The patient also felt that her urine was a higher temperature than her body temperature for 48 hours. She had to be seen again at the emergency room on 06/06 for worsening hives and hives in her eyes. She was treated and released. On 06/08, the caller was seen at her regular doctor as she did not feel well. Her antihistamines were changed to Zyrtec and she returned to work on 06/09. On 06/09, she was ataxic. She saw her doctor again on 06/11 and had finished the Medrol. Her doctor prescribed a course of tapering prednisone. On 06/12 through 06/16 or 06/17, she could not sleep as her eyelids would not shut. She was prescribed Ambien on 06/15. On 06/16, the patient went to work and was ataxic, weak, and her mouth felt like it was filled with cotton. She passed out and was taken to the hospital by ambulance. She was kept overnight and cardiac tests were performed. At the time of the follow up with the patient on 06/19, she was nauseous, had diarrhea, burning eyes (itchy, red, irritated, swollen) and felt like her lungs were the size of an apple. The patient had an appointment to see an allergist and an ophthalmologist. She was intending to schedule an appointment with the pulmonologist. The patient was advised that properly diluted product is unlikely to cause skin irritation. The main concern is ingestion of the concentrated product. The patient was advised that 2 weeks post exposure is too late to test for Diquat levels. A recommendation was made to continue to work with her doctors and to have them call should they need product information or a consult with a medical toxicologist. On follow up on 06/26/2009, the patient stated that she had stopped urinating for 36 hours on 06/21. She saw a doctor on 06/22 who diagnosed a urinary tract infection and a swollen kidney and started the patient on antibiotics. On an unknown date, the patient was diagnosed by an ophthalmologist with a chemical burn and a "blown out cornea". No treatment information was provided. The patient also reported that her previous signs are persistent, she has a raw throat and anxiety. She is currently on work restriction.The reporter also stated that no blood work or x-rays had been performed. On follow up on 07/14, the patient reported that she is feeling much better. She had seen an ophthalmologist on an unknown date and is being treated with Pataday eye drops for allergic conjunctivitis. Her remaining signs include the sore, swollen kidney and a large hive on her knee cap where she had had a meniscal injection 6 weeks prior to the product exposure. She saw an allergist and pulmonary

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

doctor on an unknown date. Unspecified blood work and urine test results are expected back on 07/27. A follow up is planned to determine the results of the lab work. Exposure to a properly diluted Diquat product would not be expected to result in the extent of signs described.