Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2013-4868

2. Registrant Information.

Registrant Reference Number: 1-34751077

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.

27-AUG-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

27-AUG-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. 24485      PMRA Submission No.       EPA Registration No.

Product Name: Avid 1.9% EC Miticide/Insecticide

• Active Ingredient(s)
  • ABAMECTIN

---

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

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

Site: Unknown / Inconnu

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 - Paresthesia

4. How long did the symptoms last?

Unknown / Inconnu

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

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

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.)

1-34751077 - The reporter indicated that he was exposed to a miticidal product containing the active ingredient abamectin. The reporter, an adult male indicated that on the day of initial contact this diluted product got sprayed on the back of his neck. About 30 minutes after the exposure the reporter washed the contaminated area. At the time of initial contact the reporter was complaining of a pins and needles feeling on the back of his neck. The reporter was advised that dermal contact may cause transient dermal irritation and topical application of vitamin E oil was recommended. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.