Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3384

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-33681720

Registrant Name (Full Legal Name no abbreviations): Syngenta 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.

16-MAY-13

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

16-MAY-13

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. 26637      PMRA Submission No.       EPA Registration No.

Product Name: Helix Seed Treatment

• Active Ingredient(s)
  • DIFENOCONAZOLE
  • FLUDIOXONIL
  • METALAXYL-M AND S-ISOMER
  • THIAMETHOXAM

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Canola

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

• General
  • Symptom - Lightheadedness
  • Symptom - Fatigue

• Nervous and Muscular Systems
  • Symptom - Dizziness

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)

Application

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Respiratory

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.)

1-33681720 - The reporter, a farmer, indicated that he was exposed to canola seeds that had been treated with the active ingredients thiamethoxam and difenoconazole. The reporter indicated that 2.5 hours prior to initial contact he had been using a seed spreader which he thought was plugged so he got on the ground and he stuck his hand under the spreader to try and unplug it. He was not wearing gloves or a mask when he did this. No seed was coming out but the fan was blowing. When he got up from the ground he felt dizzy and complained of feeling tired. The reporter was advised that inhalation of the dust may cause transient respiratory irritation as well as short term dizziness but there are numerous possible causes for dizziness including inhalation of engine fumes or standing up quickly. Reporter was further advised to seek medical attention for any recurring or on-going symptoms. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.