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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3466

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-23148401

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.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


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.


PMRA Registration No. 18450      PMRA Submission No.       EPA Registration No.

Product Name: AAtrex Liquid 480 Agricultural Herbicide

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


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?


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.


  • Gastrointestinal System
    • Symptom - Nausea
  • Skin
    • Symptom - Tingling skin
    • Specify - buring sensation
    • Symptom - Paresthesia
    • Specify - pins and needles from chest to groin

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


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)

Chemical resistant gloves

10. Route(s) of exposure.


11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

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

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.)

1-23148401- The reporter calls to indicate he believes he has been exposed to an herbicide containing the active ingredient atrazine. The caller indicates he was working with a sprayer (unspecified capacity or activity) and is concerned the gloves he was wearing as personal protective equipment may have inadequately protected him. He describes no discreet exposure but is concerned he may have gotten product on his hands. The caller reported he did thou roughly rinse his skin following the time he worked with the product. He now indicates, 12 hours later, he has awaken in the morning with symptoms of nausea and a described "burning sensation (pins and needles) on his skin from his chest to genital region". The caller asks if his perceived symptoms may be related to possible exposure. The caller was advised dermal irritation may be seen on the areas where the product actually made contact with his skin in the event of exposure. The symptoms in these circumstances are usually responsive to flushing the area with water and removing residue from the skin. That being said he was advised his symptoms were inconsistent with exposure. On routine call back two days later the reporter indicated he had seen a doctor. He reported his dermal symptoms had resolved but did not give a time line. He did report he still had mild nausea. The doctor had advised no specific care and indicated he should spontaneously resolve at home. No further information is known

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

The symptoms are not consistent with exposure to pesticide involved (atrazine).