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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-2589
2. Registrant Information.
Registrant Reference Number: PROSAR Case #: 1-26473184
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-JUN-115. Location of incident.
Country: CANADA
Prov / State: ALBERTA
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)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?
No
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?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Pesticide Spill
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.)
1-26473184- The reporter indicates exposure to an insecticide containing the active ingredient lambda-cyhalothrin. The adult male called to indicate he was exposed to the product in an occupational setting as a pest control operator. He indicates he had a small spill of the product in his truck one week prior to his initial contact with the registrant. He indicated possible dermal contact while cleaning up and potential transfer from his finger to his eye when he rubbed his eye later the same day. The reporter did not describe a discreet exposure incident. He indicated later the same day he experienced ocular irritation and decontaminated by rinsing his eye while in the shower. Since that point he has noted persistent irritation which he has treated with the OTC medication Visine. 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. The reported was supplied a MSDS sheet on the product at his request. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
