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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2678

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-22610877

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.

13-MAY-10

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

12-MAY-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)

PMRA Registration No. 26638      PMRA Submission No.       EPA Registration No. Unknown

Product Name: Helix Xtra Seed Treatment

  • Active Ingredient(s)
    • DIFENOCONAZOLE
    • FLUDIOXONIL
    • METALAXYL-M (MEFENOXAM)
    • THIAMETHOXAM

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

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.

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

  • Nervous and Muscular Systems
    • Symptom - Headache
  • Gastrointestinal System
    • Symptom - Vomiting
  • Nervous and Muscular Systems
    • Symptom - Dizziness

4. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Unknown

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)

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.)

1-22610877: The reporter called 05/13/10 to reports she was exposed to a fungicide containing the active ingredients Thiamethoxam, Dfenoconazole, Metalaxyl-M, and Fludioxonil. The caller reported working with treated seed the product was reported to have been mixed with non-company product Jumpstart and Omex Primer. The caller reported she had not touched the seed or product but had smelled it while working with the seed on 05/12/10. She reported headache, dizziness and vomiting of green stuff. The caller did not clarify the duration of exposure or the onset of symptoms. She did not give any details of personal protective equipment. The caller was advised the symptoms seen would be unexpected following exposure to the aroma of the product. She was advised to seek medical care. On routine call back the caller revealed her symptoms had resolved the morning after the reported exposure. She did not seek medical care.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

The symptoms as described are not consistent with exposure to and of the active ingredients involved.