Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3696

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-31176426

Registrant Name (Full Legal Name no abbreviations): United Agri Products Canada, Inc.

Address: 789 Donnybrook Drive

City: Dorchester

Prov / State: Ontario

Country: Canada

Postal Code: N0L1G5

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

10-AUG-12

5. Location of incident.

Country: CANADA

Prov / State: NOVA SCOTIA

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. 24613      PMRA Submission No.       EPA Registration No.

Product Name: Supra Captan 80 WDG

• Active Ingredient(s)
  • CAPTAN

---

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

4.24

Units: kg/ha

10. Site pesticide was applied to (select all that apply).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Strawberries

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

1-31176426 - The reporter indicated that the registrant product was applied at a rate of 4.24 kg/hectacre to a strawberry field approximately 10 days prior to initial contact with the registrant. The area was also treated weekly with an unnamed non-registrant fungicide. The area was re- entered by the berry picking staff two days after the registrant product was applied. No further information is available.

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: Unknown

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Rash

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

Occupational

8. How did exposure occur? (Select all that apply)

Contact with treated area

Amount of time between application and contact 2

Day(s) / Jour(s)

What was the activity? Strawberry picking

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.

Skin

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.)

1-31176426 - The reporter, a co-worker, indicated that approximately 40 people were exposed to a fungicide containing the active ingredient captan and to another unnamed non-registrant fungicide with unknown active ingredients. The reporter indicated that the registrant product was applied at a rate of 4.24 kg/hectacre to a strawberry field approximately 10 days prior to initial contact with the registrant. The area was also treated weekly with an unnamed non-registrant fungicide which the reporter indicated has not resulted in any symptoms when used previously. The area was re- entered by the berry picking staff two days after the registrant product was applied. Two to three days after the area was re-entered approximately 3-8 people out of 40 staff members developed rashes on their hands. The reporter was advised that captan has the potential to act as a skin sensitizer but there are several possible causes for a rash including exposure to environmental agents, etc. Hydrocortisone was recommended to relieve the itching and the patients were advised to seek medical attention if symptoms persisted. On follow-up call, six days later, the reporter indicated that the berry pickers were given gloves to wear while picking and all symptoms resolved within 24- 48 hours. No further information is available

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.