Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-6250

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-25012876

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.

12-OCT-10

5. Location of incident.

Country: UNITED STATES

Prov / State: PENNSYLVANIA

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.       PMRA Submission No.       EPA Registration No. 100-741

Product Name: Banner Maxx

• Active Ingredient(s)
  • PROPICONAZOLE
    • Guarantee/concentration 14.3 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Daconil (non-specific)

• Active Ingredient(s)
  • CHLOROTHALONIL
    • Unknown

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1093

Product Name: Heritage

• Active Ingredient(s)
  • AZOXYSTROBIN
    • Guarantee/concentration 50 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-769

Product Name: Medallion

• Active Ingredient(s)
  • FLUDIOXONIL
    • Guarantee/concentration 50 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-863

Product Name: Sentinel 40WG

• Active Ingredient(s)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-796

Product Name: Subdue MAXX

• Active Ingredient(s)
  • METALAXYL-M (MEFENOXAM)
    • Guarantee/concentration 22 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Triumph 4E

• Active Ingredient(s)
  • ISAZOFOS

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7. b) Type of formulation.

Liquid

Dust

Granular

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.

Other

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Death
  • Symptom - Cancer
  • Specify - Acute Myelogenous Leukemia

4. How long did the symptoms last?

Persisted until death

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

Unknown

6. a) Was the person hospitalized?

Unknown

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.)

1-25012876- The registrant was notified of the potential exposure of an adult male to several pesticides, herbicides, and fungicides. Active ingredients in the seven registrant products listed included propiconazole, chlorothalonil, azoxystrobin, fludioxonil, cyproconazole, mefenoxam, and isazofos. It was also indicated that multiple products not produced or marketed by the registrant may have been used by the allegedly exposed individual. The registrant learned of the possible exposure through pending litigation pursued by the son of a golf course superintendent/groundskeeper. The affected individual (the father) was reported to have been employed at a golf course where the listed products were in use between 1988 and 2005. No discreet exposure incident was described in the documentation received. The employee of the golf course was reported to have developed acute myelogenous leukemia and eventual died. No further information is available.

To be determined by Registrant

14. Severity classification.

Death

15. Provide supplemental information here.