Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2546

2. Registrant Information.

Registrant Reference Number: Prosar 1-18858152

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-JUN-09

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

15-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)

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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 diluted 1:4 in a back pack sprayer and applied on 06/15/2009. It is unknown where 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: Male

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

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Rash

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)

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

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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.)

1-18858152: A reporter called on 06/17/2009 to report the exposure of his co-worker to an herbicide containing the active ingredient Diquat. According to the caller, the employee was applying the product in a 1:4 dilution from a back pack sprayer on 06/15/2009. The sprayer leaked product onto the employee's hands and the back of his calves. The exposed areas were rinsed off and there were no breaks in the skin. The employee developed a rash on the back of his calves on 06/17/2009. The reporter was advised that the diluted product is not expected to result in the signs described. The reporter was also advised that the employee may have an individual sensitivity to an ingredient in the product or may be reacting to something unrelated to the product exposure. A recommendation was made for the employee to consider using an over-the-counter topical hydrocortisone cream to relieve the signs and to see a health care professional if the signs were bothersome or worsening. On follow up, the reporter stated that the employee had seen his physician on an unknown date. He received a topical cream and the signs had resolved. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.