Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4008

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-23436434

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.

13-JUL-10

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

Unknown

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. 27045      PMRA Submission No.       EPA Registration No.

Product Name: CRUISER 5FS SEED TREATMENT

• Active Ingredient(s)
  • 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: Unknown / Inconnu

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

The product, a seed treatment, had been applied to corn seed prior to exposure. The site and application rate were not provided by the reporter.

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

• Skin
  • Symptom - Pain
  • Symptom - Pruritus
  • Symptom - Rash
  • Symptom - Lesion
  • Specify - Dermal pustule/pimples

4. How long did the symptoms last?

>1 mo and <= 2mos / >1 mois et < = 2mois

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Unknown

8. How did exposure occur? (Select all that apply)

Contact with treated area

What was the activity? handling treated seed

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.

>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.)

1-23436434- The reporter calls to indicate exposure to an insecticide containing the active ingredient thiamethoxam. The caller indicates she was working with corn treated with the product two months prior to the initial contact with the registrant. She also reports working with a treated soybean seed at the same time but was unable to provide sufficient information to assist in identification of that product. The caller reports handling treated seed, placing the seed in packets. She does not clarify the capacity in which this work was done, the duration of exposure, or any personal protective equipment used. She does not describe a discreet exposure incident but states that she handled the seed. The caller reports within 2-3 days of working with the product she developed pimples, rash, itch, and dermal pain on her hands. She reports she spoke to a health care professional by phone at some point following the development of her symptoms and was instructed to apply baking soda to her hands to control the itch. The caller asked about possible treatment options. The caller was advised the length and severity of her symptoms would be unexpected following the exposure described. She was advised of symptomatic over the counter care that might be employed to alleviate her symptoms but was encouraged to seek medical advice to assist with diagnosis and address the symptoms seen. On routine call back the reporter indicated she had seen her doctor and was given a topical hydrocortisone product and her symptoms had improved.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Symptoms are not consistent with exposure to thiamethoxam. Caller indicates exposure to an un-named product on soybean seeds an this maybe involved with the symptoms recorded.