Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5846

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-24734258

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. 28821      PMRA Submission No.       EPA Registration No.

Product Name: Cruiser Maxx Beans Seed Treatment

  • 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: >6 <=12 yrs / > 6 < = 12 ans

3. List all symptoms, using the selections below.


  • Skin
    • Symptom - Erythema
    • Symptom - Rash
    • Symptom - Pruritus

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

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)


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.)

1-24734258- The reporter, an employee of a grain and feed supply retailer, indicates exposure of customer to a seed treated with the active ingredients Thiamethoxam, Metalaxyl-M, and Fludioxonil. The reporter indicated he was informed by his customer the product was handled at the beginning of the growing season and soon after dermal symptoms had developed. The exposures had not been brought to the attention of the registrant until the end of the growing season. The father of the exposed party was contacted by telephone following notification of the registrant by the vendor. The father indicated both he and his (age) son were cleaning product out of a planter at an unspecified date. No discreet exposure incident was described. The young man was wearing gloves but after the work (unspecified time frame) the boy developed an itchy red rash on both arms from the top of his glove line to the point at which his short sleeved shirt covered his arms. The father reported the symptoms lasted 3-4 days. They did not see a doctor but used OTC Calamine lotion to address the symptoms. The father reports he was doing the same work as the boy and he remained asymptomatic. No further information is available.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

Symptoms are not consistent with exposure to product.