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
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
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.