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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2006

2. Registrant Information.

Registrant Reference Number: PROSAR 1-22077989

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.


Prov / State: LOUISIANA

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.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Reward (non-specific)

  • Active Ingredient(s)
    • DIQUAT
      • Unknown

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


Other Units: gallon/25 gallons of water

10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'

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

The product was applied (1 gallon per 25 gallons of water) around and in a 3 acre pond on 03/15/2010.

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.

Medical Professional

2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.


  • General
    • Symptom - Sweating
  • Respiratory System
    • Symptom - Shortness of breath
  • General
    • Symptom - Hypothermia
  • Respiratory System
    • Symptom - Other
    • Specify - "Pulmonary infiltrates"
    • Symptom - Other
    • Specify - "Low oxygen saturation levels"
    • Symptom - Respiratory failure

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.)

1-22077989: A reporter (physician) called on 03/29/2010 to report the exposure of a male patient to an herbicide containing the active ingredient Diquat Dibromide. According to the reporter, the product was applied in a 1 gallon to 25 gallons of water dilution 2 weeks prior to the report (03/15/2010). The diluted product was sprayed around and in a 3 acre pond on a windy day, and the patient was exposed via inhalation and product blowing back on his face. The night following product application, the patient was sweating and had shortness of breath. The patient was initially seen at and managed by a different health care facility and had presented with hypothermia. The patient was transferred to the reporter's facility on 03/29/2010. At the time of the report, the patient had persistent pulmonary infiltrates, shortness of breath, and low oxygen saturation levels. The reporter was advised that the signs described are not expected following inhalation exposure given the droplet size of the product not allowing for deeper airway exposure and the fact that the product does not result in pulmonary damage as does the associated herbicide Paraquat. The reporter was advised that the ingestion of the concentrate is most likely to be associated with systemic toxicity. Unlike Paraquat, Diquat does not result in pulmonary fibrosis and distributes most significantly to the kidneys. The majority of the product-89%-is excreted in the feces while the remainder is excreted via the urine. Diquat testing information was provided to the reporter via fax. On follow up on 03/30/2010, a different physician indicated that the patient had been transferred to the ICU and was in respiratory failure and had been placed on a ventilator. The physician indicated that the patient had been on 100% oxygen at the other health care facility for an unspecified period of time which may explain some of the pulmonary infiltrates. Samples for Diquat levels had not been sent given the length of time from the actual exposure. The reporter was advised that respiratory signs are not expected following the described exposure. On follow up on 04/01/2010, the patient was improved and extubation was being considered. Renal function was within normal limits. On follow up on 04/03/2010, the patient had been discharged from the ICU to a room on the medical floor. No further information was obtained.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

The reported signs and symptoms are not consistent with exposure to Diquat.