Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3267

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-23022619

Registrant Name (Full Legal Name no abbreviations): United Agri Products Canada, Inc.

Address: 789 Donnybrook Drive

City: Dorchester

Prov / State: Ontario

Country: Canada

Postal Code: N0L1G5

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

14-JUN-10

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

15-SEP-09

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. 14617      PMRA Submission No.       EPA Registration No.

Product Name: Thionex 50W

• Active Ingredient(s)
  • ENDOSULFAN

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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-Indoor / Agricole-intérieur

Préciser le type: Greenhouse plants

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

Reporter was working in a greenhouse where the product was applied. She was in another room from where product had been applied overnight and she was exposed to the odor of the product as it exhausted through the door to where she was located.

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 - Dizziness

• Gastrointestinal System
  • Symptom - Nausea

• General
  • Symptom - Flu-like symptoms

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)

Contact with treated area

Amount of time between application and contact 12

Hour(s) / Heure(s)

What was the activity? Treated room vented into occupied room

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.)

1-23022619: The reporter notified the registrant on 6/14/10 of her exposure in 9/2009 to fumes from an insecticide product containing the active ingredient Endosulfan. According to the reporter, she was acutely exposed one time while working in a greenhouse where the product had been applied. She was in another room from where product had been applied overnight, and was exposed to the odor of the product as it exhausted through the door to where she was located. There was no direct exposure to the product. The reporter developed dizziness and nausea at some unspecified time after the exposure; symptoms lasted 3 days. The reporter indicated that she has had slight symptoms ever since the initial exposure - in 3/2010 she had the flu and all the symptoms came back (duration unknown). The reporter stated she felt that she must have been poisoned. During the 6/14 call, the safety profile of the product was discussed in terms of typical symptoms and the time frame in which they would develop after an exposure. Also discussed was the fact that: a) systemic toxicity would not be anticipated from smelling the odor of the product that was applied the night before; b) inhalation exposures would be treated by removing the patient from the source of the fumes; and c) most cases of acute toxicity would recover within 24-48 hours unless ongoing absorption occurs or complications develop. Lastly, the reporter was informed that dizziness and nausea may result while in the presence of a noxious odor for a period of time (odor effect), but no long term health consequences would be expected from such an exposure. Any symptoms that recurred over time which resembled the original symptoms or flu-like symptoms would not be expected.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

The reporter was informed that dizziness and nausea may result while in the presence of a noxious odor for a period of time (odor effect), but no long term health consequences would be expected from such an exposure. Any symptoms that recurred over time which resembled the original symptoms or flu-like symptoms would not be expected.