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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-4009
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-23483996
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.
16-JUL-105. Location of incident.
Country: CANADA
Prov / State: SASKATCHEWAN
6. Date incident was first observed.
16-JUL-10Product 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)PMRA Registration No. 24984 PMRA Submission No. EPA Registration No.
Product Name: Matador 120EC Emulsifiable Concentrate Insecticide
- Active Ingredient(s)
- LAMBDA-CYHALOTHRIN
7. b) Type of formulation.
Application Information
8. Product was applied?
Unknown
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?
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
- Eye
- Symptom - Irritated eye
4. How long did the symptoms last?
>8 hrs <=24 hrs / > 8 h < = 24 h
5. Was medical treatment provided? Provide details in question 13.
No
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)
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
Eye
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
<=30 min / <=30 min
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.)
1-23483996- The reporter indicates exposure to an insecticide containing the active ingredient lambda-cyhalothrin. The caller indicates working with the concentrated product earlier in the day. He does not indicted in what capacity he was handling the product or what personal protective equipment was in use. He reports getting the concentrated product on his hand and inadvertently transferring product to his eye by rubbing that area with his hand. The caller reports rinsing the two exposed areas but that the ocular irritation has persisted. The exposure took place one hour prior to the initial contact with the registrant. The caller was advised the product could behave as both an ocular and dermal irritant. He was advised of decontamination procedures and the threshold at which he might seek medical care. On routine cal back the reporter indicated his symptoms had resolved within 24 hours of the exposure. He did not need to seek medical care. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
