Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3385

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-33674060

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.

15-MAY-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

11-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. 28821      PMRA Submission No.       EPA Registration No.

Product Name: CRUISER MAXX BEANS SEED TREATMENT

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

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PMRA Registration No. 30438      PMRA Submission No.       EPA Registration No.

Product Name: VIBRANCE 500FS SEED TREATMENT

• Active Ingredient(s)
  • SEDAXANE

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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: Soybeans

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

• Skin
  • Symptom - Red skin
  • Symptom - Irritated skin

• General
  • Symptom - Swelling
  • Symptom - Flu-like symptoms

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Yes

6. a) Was the person hospitalized?

No

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)

Unknown

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

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.)

1-33674060 - The reporter indicated that he was exposed to treated soybean seeds which had been treated with the active ingredients thiamethoxam, metalaxyl-m, Fludioxonil and sedaxane. The reporter indicated that four days prior to initial contact with the registrant he was pouring the seeds in a spreader for a period of about one hour and during that time he was not wearing gloves. The reporter's hands turned blue during the exposure and afterwards he washed his hands for a minute or two. That night his face was red and felt like it was burning. The next morning one side of his face was swollen and he felt like he had the flu. He went to the ER that same night where they thought he might have been stung by an insect and he was treated with antibiotics. The following day, the reporter still felt like he had the flu and he went to his doctor for some new swelling that had developed under his eye. At the time of initial contact, the reporter states that the initial swelling on his face had improved but he did develop new swelling near his eye yesterday. The reporter was advised that the described symptoms are not expected with exposure to the product. Dermal exposure to the product may cause transient skin irritation but swelling is not typically seen unless the patient has an allergy either to this product or something else. The reporter was further advised to continue working with his doctor to determine a cause and appropriate treatment for his symptoms. The reporter could not be reached on follow-up. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.