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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3607

2. Registrant Information.

Registrant Reference Number: 10072101

Registrant Name (Full Legal Name no abbreviations): Nufarm Agriculture Inc.

Address: 5507 1st Street SE

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2H 1H9

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


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: GEORGIA

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.       PMRA Submission No.       EPA Registration No. 228-179-59144

Product Name: Green Charm Weed Feed 10-6-4

  • Active Ingredient(s)
      • Unknown
      • Unknown
      • Unknown

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: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.


  • Eye
    • Symptom - Blindness (temporary)
    • Symptom - Burn on the eye

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)

Pesticide Spill

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


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.)

There was a spill of the product at work (name greeter) on May 22, 2010 and she had eye contact with the product. Caller states she was diagnosed with an alkaline burn to her eye and subsequently lost sight in that eye (unsure if temporary or permanent loss). Caller states that there is another spill of the product at work today and she would like clean-up information. Caller is concerned because she does not want to lose additional sight and is currently having to get brain injections.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

Name of product was obtained from the bag. Has any exposure or injury occurred before, yes (see above re initial call). Where and when did the spill occur, (name) May 22, 2010 and July 20, 2010. What quantity spilled? 40 lbs each time (bags stacked 10 high, not 2 high as directed on the label). Has the spill entered a water way? No. Is there potential for entering ground water? No. What clean up procedures have been initiated? 1/2 cup full is still on the floor, a co-worker pushed the rest of the product off the counter and swept it up. Who is performing the clean up? store employee. Is the clan up assistance requested from this client (other than MSDS instructions)? Yes. Because of her claim that the product caused her vision issues, she is afraid to get near the product and wants to know from the company how to clean up a spill properly. Her manager told her after the May 22, 2010 spill that she could clean it up like she would clean up flour so caller did not take any precautions at that time. Per the caller, the person who cleaned the spill up yesterday is fine. Advised caller that generally, the product may act as an eye irritant and due to the granular formulation may cause corneal abrasions if not rinsed properly but the extent of her symptoms as described including the need for brain injections and loss of vision requiring surgery is not expected. Nufarm found proper EPA registration number. Should be #as the number given is a firm in (country). MSDS was forwarded to the caller. Relayed that clean up of spills includes sweeping up material and placing it in a closed container for disposal.