Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-4375

2. Registrant Information.

Registrant Reference Number: Prosar 1-19954052

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.

15-SEP-09

5. Location of incident.

Country: UNITED STATES

Prov / State: IDAHO

6. Date incident was first observed.

Unknown

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.       PMRA Submission No.       EPA Registration No.

Product Name: Diquat (non-specific)

• Active Ingredient(s)
  • DIQUAT
    • Unknown

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7. b) Type of formulation.

Liquid

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: Potato

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

The product was applied to an adjoining potato field on an unspecified day in 07/2009.

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: Female

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

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Chills

• Gastrointestinal System
  • Symptom - Abdominal distension

• Nervous and Muscular Systems
  • Symptom - Memory loss

• General
  • Symptom - Edema
  • Specify - Generalized swelling

• Skin
  • Symptom - Peeling skin
  • Specify - Lost the top layer of her skin
  • Symptom - Other
  • Specify - Scarring
  • Symptom - Other
  • Specify - "Knots on her leg"

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Drift from the application site

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

Respiratory

Unknown

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.)

1-19954052: A reporter called on 09/15/2009 to report her possible exposure to an herbicide containing the active ingredient Diquat. According to the reporter, she was mowing her lawn in the beginning of July 2009 while the product was being sprayed on the neighboring potato field. The reporter stated that she may have had dermal or inhalation exposure to product drift. The reporter went inside and had the chills and a swollen abdomen. She also noted that her dog's abdomen appeared swollen. The reporter then lay down on the couch and had no memory of the following week. She stated that she did not get up at all during that time, and had developed generalized skin swelling and lost the top layer of her skin at some point. She finally saw a doctor at the end of that week on 08/04/2009. The doctor gave the reporter 2 cortisone shots and a salve. She saw her primary care physician after her initial appointment with the other physician and was prescribed erythromycin, pain medication, and "nerve pills". At the time of the call, the reporter had a scar on her leg from the incident. She also described having knots on her leg. The reporter was advised that the signs described are not consistent with the potential exposure described. The reporter was also advised that properly diluted solutions would not be expected to result in skin irritation unless clothing is soaked and the product is left on the skin for long periods of time. Intact skin is an effective barrier; however, skin lesions or prolonged exposure to a diquat-containing product could potentially result in systemic toxicity. Overexposure to diquat mist may result in respiratory irritation. A recommendation was made to continue working with the reporter's physicians to determine the cause and appropriate treatment of her signs. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

The symptoms reported are not consistent with exposure to the product.