Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-2017

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-37072130

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-APR-14

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

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.

Active(s)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-898

Product Name: Agri-Mek 0.15EC Miticide Insecticide

• Active Ingredient(s)
  • ABAMECTIN
    • Guarantee/concentration 2 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-896

Product Name: Avid 0.15EC Miticide Insecticide

• Active Ingredient(s)
  • ABAMECTIN
    • Guarantee/concentration 2 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 50534-188-10182

Product Name: Bravo Weather Stik

• Active Ingredient(s)
  • CHLOROTHALONIL
    • Guarantee/concentration 54 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-667

Product Name: Citation

• Active Ingredient(s)
  • CYROMAZINE
    • Guarantee/concentration 75 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 50534-209

Product Name: Daconil Weather Stik

• Active Ingredient(s)
  • CHLOROTHALONIL
    • Guarantee/concentration 54 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1154

Product Name: Epi-Mek 0.15EC Miticide Insecticide

• Active Ingredient(s)
  • ABAMECTIN
    • Guarantee/concentration 2 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1217

Product Name: Gramaxone Inteon

• Active Ingredient(s)
  • PARAQUAT
    • Guarantee/concentration 30 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1217

Product Name: Gramaxone SL

• Active Ingredient(s)
  • PARAQUAT
    • Guarantee/concentration 30 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1093

Product Name: Heritage

• Active Ingredient(s)
  • AZOXYSTROBIN
    • Guarantee/concentration 50 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-769

Product Name: Medallion

• Active Ingredient(s)
  • FLUDIOXONIL
    • Guarantee/concentration 50 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-1202

Product Name: Ridomil Gold SL

• Active Ingredient(s)
  • METALAXYL-M (MEFENOXAM)
    • Guarantee/concentration 45.3 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-828

Product Name: Vangard WG

• Active Ingredient(s)
  • CYPRODINIL
    • Guarantee/concentration 75 %

---

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

Product Name: unknown

• Active Ingredient(s)
  • THIAMETHOXAM

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-617

Product Name: Tilt

• Active Ingredient(s)
  • PROPICONAZOLE
    • Guarantee/concentration 41.8 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-796

Product Name: Subdue Maxx

• Active Ingredient(s)
  • METALAXYL-M (MEFENOXAM)
    • Guarantee/concentration 22 %

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 100-953

Product Name: Switch 62.5 WG

• Active Ingredient(s)
  • CYPRODINIL
    • Guarantee/concentration 37.5 %
  • FLUDIOXONIL
    • Guarantee/concentration 25 %

---

7. b) Type of formulation.

Liquid

Dust

Granular

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: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Cancer
  • Specify - acute myelogenous leukemia

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?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Unknown

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>6 mos / > 6 mois

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.)

1-37072130 - The reporter, a lawyer, indicated that an adult female was exposed to numerous registrant insecticides, fungicides and herbicides containing the active ingredients abamectin, thiamethoxam, Chlorothalonil, cyromazine, Paraquat dichloride, azoxystrobin, mefenoxam, cyprodinil, fludioxonil and propiconazole. The reporter also indicated that the patient was exposed to numerous other non-registrant products with unknown active ingredients. The reporter states that the patient worked with various employers from 1989 to 2012 and during the course of the patients employment she was exposed to these products. The nature of the exposure and the routes of exposure were not described. In 2012, the patient was diagnosed with acute myelogenous leukemia and per the reporter the patient has been hospitalized and undergone unspecified surgery, other unspecified treatments, and may require unspecified organ transplantation. The registrant became aware of these allegations through litigation. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.