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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-4369

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.

Human

Residues in Food

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

23-JUL-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)

PMRA Registration No. 29767 PMRA Submission No. EPA Registration No.

Product Name: CARAMBA FUNGICIDE

Active Ingredient(s)
- METCONAZOLE

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

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

The start of fungicide spraying, released from a crop sprayer airplane, was about 100 feet from the edge of my yard. It drifted on a slow breeze across the road and onto my property, which is totally encircled by trees and brush behind my home. The crop sprayer flew over my yard and sprayed for about 20-25 minutes. I had no prior notice of this event and was outdoors with my pets in my organic garden at the time it began. The application of the pesticide was aerial, via a crop sprayer airplane, onto a field directly across the road from my property and starting approximately 400 feet from my house. The duration of the spraying was 20-25 minutes.

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: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

Eye
- Symptom - Dry eye
- Symptom - Burning eye
- Symptom - Pain
- Specify - sore

Respiratory System
- Symptom - Irritated nose
- Specify - nasal passages sore and red
- Symptom - Respiratory pain
- Specify - trachea hurt
- Symptom - Difficulty Breathing

Cardiovascular System
- Symptom - Chest pain

Gastrointestinal System
- Symptom - Sore throat
- Symptom - Dry throat

4. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Hour(s) / Heure(s)

7. Exposure scenario

Non-occupational

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)

None

10. Route(s) of exposure.

Skin

Eye

Oral

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 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.)

After the fungicide spray came into my yard on July 23, 2013 my eyes became dry and felt burning and sore. They looked red and were sore as were my nasal passages and later my trachea hurt. At the time my throat became dry and sore and I had difficulty breathing and pain in my throat and chest. The next day, July 24, I was admitted to hospital, saw a doctor and had two chest x-rays. The doctor prescribed eye drops, (Olopatadine) and over the counter nasal spray and lotion for the skin on my face. I was discharged the same day. It took a week for the skin on my face to heal. My eyes healed in about 15 days. On August 6 I saw my family doctor because my nasal passage was still sore and my trachea hurt. Since then it has healed but my chest still hurts if I have to breath heavily. The hospital chest x-rays taken on July 23 were clear.This incident has been reported to Transport Canada, and Manitoba Agriculture Pesticide Control Application. Manitoba Agriculture spoke with BASF on my behalf in regards to the incident and to ask if my garden produce was safe to eat. I am also filing a Health Canada Environmental Incident Report. A separate incident report was submitted, the information provided is as follows: The product name is Caramba PCP # 29767. The application of the pesticide Caramba was aerial from a crop sprayer airplane. The site is a field of wheat across the road from my property which was sprayed for about 20-25 minutes.Approx one thousand, one hundred (1100) exposed plants in two different gardens. BASF reports that the maximum residue limit is 4-21 days from exposure, but they said that we could eat the product if we washed it really well: As per the conversation I had with Manitoba Agriculture Pesticide Application. The plants are still in the garden. Now I cannot sell them at a farmers market as I do not know if they exceeded the maximum residue limit. We also do not know if our organic garden now has pesticide residue.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

Subform V: Residues in Food

1. Pesticide(s) and degradate(s) analysed for

2. Concentration of pesticide/degradate in food

3. Corresponding limit of detection

4. Sample Type

Unknown

5. Method of analysis (include if a confirmatory method was used in addition to the screening method)

Sample Information

6. What is the reason the sample was collected (e.g. complaint, inspection, process monitoring)?

7. What organization collected the sample?

Unknown

8. From what point in the distribution channel was the sample taken?

Unknown

9. How large was the food commodity from which the sample was taken?

10. How many samples were taken?

11. How large was the sample size?

12. What action was taken based on the violative residue?

Unknown

For Registrant use only

14. Provide supplemental information here

The application of the pesticide Caramba was aerial from a crop sprayer airplane. The site is a field of wheat across the road from my property which was sprayed for about 20-25 minutes. Approx. One thousand, one hundred (1100) plants in two different gardens. BASF reports that the maximum residue limit is 4-21 days from exposure, but they said that we could eat the produce if we washed it really well: As per the conversation I had with Manitoba Agriculture Pesticide Application. The plants are still in the garden. Now I can not sell them at a farmers market as I do not know if they exceed the maximum residue limit. We also do not know if our organic garden now has pesticide residue. The samples have not been analysed yet.