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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-2548
2. Registrant Information.
Registrant Reference Number: Prosar 1-19047655
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.
03-JUL-095. Location of incident.
Country: CANADA
Prov / State: SASKATCHEWAN
6. Date incident was first observed.
30-JUN-09Product 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. 24076 PMRA Submission No. EPA Registration No.
Product Name: Horizon 240EC (+ Score)
- Active Ingredient(s)
- CLODINAFOP-PROPARGYL
7. b) Type of formulation.
Application Information
8. Product was applied?
Unknown
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
- Skin
- Symptom - Burning skin
- Eye
- Symptom - Burning eye
- 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?
No
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.
Skin
Eye
11. What was the length of exposure?
<=15 min / <=15 min
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.)
1-19047655: A reporter (patient's father) called on 07/03/2009 to report the exposure of his son to an herbicide containing the active ingredient Clodinafop-Propargyl and an unknown non-company tank-mix product. According to the reporter, his son was using a chem handler on 06/30/2009 when the open valve sprayed concentrated product and concentrated non-company product in his face and eyes. His son accidentally grabbed another hose of diluted products instead of the water hose and sprayed more diluted products in his face. He then showered, rinsed completely, and used Visine in his eyes. His eyes and skin burned the rest of the day. These signs resolved by 07/01/2009, but he then developed diarrhea. The reporter was advised that the product can be an eye and skin irritant. The reporter was also advised that showering for 20 minutes after exposure, rinsing eyes for 20 minutes, and avoiding over-the-counter eye drops are recommended. The product may result in diarrhea with ingestion, but it is not expected as a result of dermal exposure. The reporter was advised to call the non-company tank-mix product manufacturer with regard to that product's safety profile. On follow up, the reporter stated that his son's diarrhea had resolved at an unknown time and was thought to be from a virus. No further information was obtained.
To be determined by Registrant
14. Severity classification.
Minor
