Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3195

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-23052399

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.

16-JUN-10

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

07-JUN-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. 24984      PMRA Submission No.       EPA Registration No.

Product Name: Matador 120EC Emulsifiable Concentrate Insecticide

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

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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 caller specified routine application of the diluted product on ha farm, nothing further is known

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: >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
  • Symptom - Anorexia

• Respiratory System
  • Symptom - Difficulty Breathing

4. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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.)

1-23052399- The reporter calls to indicate her father may have been exposed to an insecticide containing the active ingredients Lambda-Cyhalothrin. The reporter indicates her father applied diluted product in an unspecified manner nine days before the initial contact to the registrant. The caller did not describe or indicate a discreet exposure or route of exposure. It was not specified if personal protective equipment was used during application. She reports her father developed symptoms of difficulty breathing, headache, and vomiting two days after he had worked with the product. The caller indicated the breathing difficulty was mild and had subsided, but the remaining symptoms had persisted. The caller was told the symptoms and time lines were inconsistent with exposure to this product. She was advised to seek medical attention for her father. On routine call back the reporter indicated symptoms persisted for two days. They believed the symptoms were due to something the patient had eaten rather than exposure to the product.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

The symptoms are not consistent with exposure to Lambda=cylothrin. The time of onset is too long after any 'potential' exposure. The reporter believes the symptoms observed were due to some ingested food.