Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3200

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-22847297

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.

02-JUN-10

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

31-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)

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PMRA Registration No. 27071      PMRA Submission No.       EPA Registration No. Unknown

Product Name: Maxim XL Seed treatment

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

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PMRA Registration No. 28821      PMRA Submission No.       EPA Registration No. Unknown

Product Name: Cruiser Maxx Beans Seed treatment

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

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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: Treated seed (including beans)

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

The reporter handled treated seed on or about 5/26/10 using rubber coated gloves (coated on the fingers and palms), but the material across the back of the hands was plain mesh or cloth. Symptoms developed 5 days 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 - Red skin
  • Symptom - Irritated skin

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.

Skin

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>3 days <=1 wk / >3 jours <=1 sem

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.)

1-22847297: The reporter called on 6/2/10 to report his exposure approximately one week previously to seed which had been treated with two different fungicide products. The products collectively contained the active ingredients Fludioxonil, Metalaxyl-M, and Thiamethoxam. According to the reporter, he had worn rubber coated gloves while handling the seed. The reporter indicated that the gloves had been rubber coated on the fingers and palms, but the material across the back of the hands had been plain mesh or cloth. About 5 days after using the treated seed, the reporter developed irritated, erythematous skin on the backs of his hands. Symptoms had persisted until the time of the call (48 hours). During the 6/2/10 call, full coverage personal protective gloves were recommended for future consideration. The safety profile of both products was discussed, and a recommendation was made to use over the counter topical hydrocortisone cream to try and alleviate symptoms. It was also recommended to seek medical care if symptoms persisted beyond 48 hours with the use of the hydrocortisone cream, or if symptoms spread or worsened in intensity. Other potential causes of a rash were discussed, including sensitivities to household or commercial products, foods, medications, heat, and naturally occurring environmental agents.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

The reporter was not wearing chemical resistant gloves as per label directions.