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: 2009-4281

2. Registrant Information.

Registrant Reference Number: Prosar 1-19740840

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.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA


6. Date incident was first observed.


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.


PMRA Registration No. 26396      PMRA Submission No.       EPA Registration No.

Product Name: Reglone Liquid Herbicide/Desiccant

  • Active Ingredient(s)
    • DIQUAT

7. b) Type of formulation.

Application Information

8. Product was applied?


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?


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.


  • Skin
    • Symptom - Tingling skin
    • Symptom - Dry skin
    • Symptom - Burning skin
    • Specify - Skin feels like it is sunburned

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


8. How did exposure occur? (Select all that apply)


9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


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.)

1-19740840: A reporter called on 09/03/2009 to report his exposure to an herbicide containing the active ingredient Diquat. According to the reporter, he was filling a tank with diluted product on 09/01/2009 when it spilled onto the intact skin of his forearm. He rinsed the affected area briefly. His forearm started to tingle later in the day on 09/01/2009. The tingling had resolved at the time of the report, but his skin appeared dry and felt like it had a sunburn. The reporter was advised that properly diluted solutions are unlikely to cause irritation unless the clothing is soaked and product is left on the skin for extended periods of time. Intact skin is an effective barrier to the active ingredient and systemic toxicity is unlikely with the described exposure. A recommendation was made to apply vitamin E oil or aloe vera products to the affected area. The reporter was advised not to apply creams or lotions to open sores, blisters, or peeled skin. A recommendation was made to consult a physician since the signs had persisted for more than 24 hours. An attempt at follow up was unsuccessful. No further information was obtained.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.