Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-4869

2. Registrant Information.

Registrant Reference Number: 1-34610718

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.

14-AUG-13

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

14-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Touchdown (unspecified)

• Active Ingredient(s)
  • GLYPHOSATE

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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: Unknown

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 - Other
  • Specify - Felt hotter than normal

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

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

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?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

1-34610718 - The reporter, a crop insurance provider, indicated that he was exposed to an herbicide containing the active ingredient glyphosate. The reporter stated that ten minutes prior to initial contact with the registrant the crop that he was in was sprayed with this product and after the application he had to walk back through the wet field. At the time of initial contact the reporter indicated that he felt hotter than normal. The reporter was advised that the product has a wide margin of safety but dermal contact to the wet product may cause transient skin irritation. A thorough rinsing was recommended to help prevent skin irritation. On follow-up call, one day later, the reporter indicated that his face and lips were red and irritated. Topical application of vitamin E or aloe products was recommended to relieve the irritation. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.