Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3472

2. Registrant Information.

Registrant Reference Number: Prosar 1-19454888

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.

08-AUG-09

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

08-AUG-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. 24984      PMRA Submission No.       EPA Registration No.

Product Name: Matador 120EC Emulsifiable Concentrate Insecticide

  • Active Ingredient(s)
    • LAMBDA-CYHALOTHRIN

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: Soybeans

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

The product was sprayed on soybeans on 08/08/2009.

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

3. List all symptoms, using the selections below.

System

  • Skin
    • Symptom - Burning skin
    • Symptom - Itchy skin
    • Symptom - Paresthesia
    • Specify - "Stinging"
  • Nervous and Muscular Systems
    • Symptom - Numbness

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.)

1-19454888: A reporter called on 08/08/2009 to report his exposure to an insecticide containing the active ingredient lambda-Cyhalothrin. According to the reporter, he was spraying the product on his soybeans and may have gotten some blow back mist on his face. The reporter showered and changed his clothes after using the product. He developed stinging, burning, itching, and numbness on his face within 3 hours of product use. The reporter was advised that the signs described are typical of paraesthesia than can develop as a result of dermal exposure to the product. Paraesthesia generally resolves spontaneously within 24 hours. The reporter was advised that rinsing the exposed skin and changing clothes following exposure is appropriate. A recommendation was made to apply vitamin E oil or aloe vera as needed to the affected area to help reduce the intensity and duration of the signs. On follow up, the reporter stated that his signs resolved within 24 hours. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.