Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2009

2. Registrant Information.

Registrant Reference Number: PROSAR 1-22333703

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.

21-APR-10

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

28-JAN-10

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. 100-1173

Product Name: Discover NG Herbicide

• Active Ingredient(s)
  • CLODINAFOP-PROPARGYL

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

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?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache

• Gastrointestinal System
  • Symptom - Nausea

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)

Unknown

10. Route(s) of exposure.

Respiratory

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.)

1-22333703: The reporter, an employee of the registrant, on 4/21/10 electronically communicated notification of an exposure of a male worker (age unspecified) to an herbicide product containing the active ingredient Clodinafop-propargyl. According to the reporter, on 1/28/10 the employee was filling containers of the product and complained about a headache and nausea. There was an odor coming from the product in the containers during the transition from the fill section to the capping machine. The employee was told to get and wear his air purifying respirator (Personal Protective Equipment or PPE) until the problem could be addressed. No details are available regarding the treatment or duration of the employees symptoms. Actions taken to address the issue included installing an exhaust pick up to draw fumes away from the operator area, as well as having the fill machine operator wear an air sample unit to measure the level of vapor in his work area from the product.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Patient symptoms are consistent with respiratory irritation from exposure to product fumes.