Health Canada
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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3585

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

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. 27322      PMRA Submission No.       EPA Registration No.


  • 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).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Corn field

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Aerial application by helicopter on corn field directly on other side of my backyard fenceline. As per label, the application rate is 0.4 - 0.6 L/ha * DO NOT apply more 0.4 L/ha by aerial application*.

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: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.


  • Nervous and Muscular Systems
    • Symptom - Headache
    • Specify - severe headache
  • Gastrointestinal System
    • Symptom - Irritated throat
  • Nervous and Muscular Systems
    • Symptom - Muscle twitching
    • Symptom - Dizziness
    • Symptom - Muscle pain
  • General
    • Symptom - Joint pain
  • Nervous and Muscular Systems
    • Symptom - Other
    • Specify - extreme pressure in hands
  • Gastrointestinal System
    • Symptom - Mouth Irritation
    • Specify - irritation inside mouth
  • Skin
    • Symptom - Irritated skin

4. How long did the symptoms last?

Unknown / Inconnu

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)

Drift from the application site

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?

>2 hrs <=8 hrs / >2 h <=8 h

12. Time between exposure and onset of symptoms.

>2 hrs <=8 hrs / > 2 h < = 8 h

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.)

Severe headache, throat irritation, dizziness, muscle twitching, extreme pressure in hands, skin irritation, muscle and joint pain within 2 hours of initial exposure. Irritation inside mouth after eating food in home. Removed self to fresh air in woodland 15 minutes drive from home to relieve symptoms as per first-aid measures viewed online. Returned on two other occasions when felt better during day only to have symptoms reoccur each time causing me to leave again. Saw Board of Health day of incident to report it. Saw emergency doctor at hospital the day after incident; no antidote available, no treatment given, recommended to say away from home 2-3 days, keep home closed with air conditioning on, which I did and installed expensive furnace filter for trapping allergens, etc. Saw Board of Health again the next day to get results of their inquiries from OMAFRA, provided with Safety Data Sheet and Label of product, recommended to call MOE, called MOE. Went into house after 4/10 inches rainfall 3 days after spraying, symptoms reoccurred within 30 minutes, when opened window I experienced an immediate headache upon smelling the residual spray. Saw clinic doctor 1 week after exposure and received blood test for toxins the following day. Returned to home after 3/4 inches rainfall, 10 days after spraying, symptoms reoccurred within 15 to 20 minutes. Have not been able to live in home since spraying occurred as symptoms reoccur within the decreasing lengths of time each time I enter home , at 15 days at time of writing. Inhalation. Awaken by helicopted in field. Bedroom windows were open for the night but were closed within minutes of smelling odour and visual sighting of helicopter confirmed spraying. Spraying occurred directly behind my property and also in a field at the end of my street, just one house away. Spraying lasted 1.5 hours or more. I took garbage out 1.5 hours after spraying was finished and the air was polluted with the spray to the point that I tried not to breathe. Left home within the next hour. After the initial exposure, I have been exposed to the spray and/or surfactant trapped in my home for brief periods of time on 5 to 7 occasions when picking up items or testing the air after a rain. The label has no specific requirements regarding buffer zones for the protection of human habitats!! Legislation does not require notification to neighbouring residential areas. This product was discontinued in the USA. Recommendations to Health Canada and/or the appropriate regulatory agencies or powers: 1. Include specific buffer zones distances required for the protection of human habitat on the label. This should exceed distances already identified on the label. 2. Require notification to individual neighboring residential homes prior to use of the product. Suggested method, Hire a student team to hand-deliver flyers to neighbouring homes. 3. Discontinue use of the product in Canada. It is poison. 4. Work toward the discontinuation of using any poison in the growth and maintenance of food/crops in Canada in favour of organic farming.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.