Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2588

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-26510370

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.

15-JUN-11

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

15-JUN-11

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)

---

PMRA Registration No. 29201      PMRA Submission No.       EPA Registration No.

Product Name: Traxion

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS POTASSIUM SALT)

---

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 - Tearing
  • Symptom - Irritated eye

4. How long did the symptoms last?

Unknown / Inconnu

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

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.

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.)

1-26510370-The reporter indicated an exposure to an herbicide containing the active ingredient glyphosate. The adult male reporter stated within four hours of his initial contact with the registrant he had gotten some concentrated product in his eye. He did not clarify the circumstances in which the exposure took place or in what capacity he was working with the product. He reported he had flushed his eye for a few seconds and has used the OTC medication Visine to alleviate the burning, tearing and tingling to his eye he described had persisted. The reporter asked for additional recommendations. The reporter was advised of the potential ocular irritant effect of the product following exposure by that avenue. He was advised of proper decontamination, and symptomatic care. He was advised of the threshold at which he should seek medical care should his symptoms persist or worsen. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.