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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5847

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-24734251

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.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

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.

PMRA Registration No. 28821      PMRA Submission No.       EPA Registration No.

Product Name: Cruiser Maxx Beans Seed Treatment

• Active Ingredient(s)
  • FLUDIOXONIL
  • METALAXYL-M (MEFENOXAM)
  • THIAMETHOXAM

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

• Skin
  • Symptom - Blister
  • Symptom - Pruritus

4. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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

Occupational

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.

Unknown

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.)

1-24734251- 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 exposed party was contacted by telephone following notification of the registrant by the vendor. The exposed individual indicated he had handled the product in both June/09 and June/10. No discreet exposure incident was described. Following both occasions (at an unspecified interval) he reported he developed itchy fluid filled blisters on his forearms. The symptoms were reported to have been milder in 2010. On both occasions he reported he saw his doctor and was given a cream to address the symptoms. He indicates the physician he had seen had thought his symptoms were consistent with poison oak exposure. In both instances he indicated the symptoms persisted for 2-3 weeks. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Symptoms are not consistent with exposure to product. According to the treating physician, may have been caused by exposure to poison oak. Label directs wearing long-sleeved shirt and chemical resistant gloves when handling treated seed.