Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3140

2. Registrant Information.

Registrant Reference Number: Prosar 1-19194939

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.

16-JUL-09

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

15-JUL-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. 24984      PMRA Submission No.       EPA Registration No.

Product Name: Matador 120EC Emulsifiable Concentrate Insecticide

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

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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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Unknown

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

The product was diluted with an non-company product and applied to a 700 acre area on 07/14/2009.

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: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Burning skin

4. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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

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

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.)

1-19194939: A reporter called on 07/16/2009 to report his exposure to an insecticide containing the active ingredient Lambda-cyhalothrin. According to the reporter, he diluted the product with a non-company product and applied it to a 700 acre area on 7/15/2009. He may have gotten product mist on his face during product application. While using the product, he developed a burning sensation on his face. He washed his face twice while using the product and then again when he finished applying the product. His signs were much improved at the time of the report. The reporter indicated that the same thing happened 2 weeks prior and that his signs resolved within 24-48 hours. The reporter was advised that dermal exposure to the product may result in a temporary burning, itching, numbness, or tingling sensation. These signs usually develop soon after exposure and resolve spontaneously within 24 hours. It is recommended to remove contaminated clothing and rinse the exposed area for 20 minutes when dermal exposure does occur. Vitamin E oil may be used on the affected areas to help reduce the intensity and duration of the signs. A recommendation was made to consult a health care provider should the signs persist longer than 24 hours. The reporter was advised that he may wish to contact the manufacturer of the non-company product to determine whether he needs to have concerns about that exposure. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.