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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5436

2. Registrant Information.

Registrant Reference Number: 1-34780554

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.

5. Location of incident.

Country: UNITED STATES

Prov / State: ILLINOIS

6. Date incident was first observed.

Unknown

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.

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

Product Name: unknown

• Active Ingredient(s)
  • ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
    • Unknown

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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

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.

Other

2. Demographic information of data subject

Sex: Male

Age: >1 <=6 yrs / > 1 < = 6 ans

3. List all symptoms, using the selections below.

System

• Reproductive System
  • Symptom - Birth defect
  • Specify - Hypospadias

4. How long did the symptoms last?

Anticip. permanent/Permanence anticipée

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

2

Week(s) / Semaine(s)

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Other

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.

Oral

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.)

1-34780554 - The reporter, a mother, indicated that her infant son may have been exposed to an herbicide containing the active ingredient atrazine and to other non-registrant products with unknown active ingredients. The reporter only provided the active ingredient for the product and did not provide a product name or registration number. The reporter indicated that her son was born on January 3, 2007 with hypospadias and she alleges that the birth defect was due to her drinking tap water before and during her pregnancy from an (state) public water system that contained atrazine. The reporter's son has since undergone surgery to repair his urethra and was hospitalized for two weeks after the corrective surgery. The registrant was made aware of the possible exposure through pending litigation that was received on 8/20/2013. Several other companies have also been named as defendants in the law suit. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.