Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2001

2. Registrant Information.

Registrant Reference Number: PROSAR 1-22276301

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-APR-10

5. Location of incident.

Country: CANADA

Prov / State: UNKNOWN

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)

---

PMRA Registration No. 29089      PMRA Submission No.       EPA Registration No.

Product Name: Horizon NG Herbicide

• Active Ingredient(s)
  • CLODINAFOP-PROPARGYL

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: non-company Thumper

• Active Ingredient(s)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: non-company Prestige

• Active Ingredient(s)

---

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 mixed with non-company Thumper and sprayed on an unknown date in Spring 2009. The product was mixed with non-company Prestige and sprayed one week later.

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 - Rash
  • Symptom - Pruritus

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Occupational

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)

Chemical resistant gloves

Chemical resistant coveralls

10. Route(s) of exposure.

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.)

1-22276301: A reporter (client employee) reported on 04/08/2010 the exposure of a male grower to an herbicide containing the active ingredient Clodinafop-propargyl. On an unknown date in the spring of 2009, the grower mixed the product with the non-company product Thumper and applied the combined products. He was wearing a Tyvex suit and rubber gloves during the application. Later on the day of product application, the grower developed a pruritic rash on his upper body and arms. One week later, he mixed the product with non-company Prestige and applied the combined products while wearing the same protective equipment. Following product application, the rash spread to the grower's entire body and the pruritis intensified. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Skin irritation is possible following dermal contact with the product. The extent of rash and pruritis described by the grower is not expected without an individual sensitivity to an ingredient in the product.