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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-7842

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-45960889

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.

17-OCT-16

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

17-OCT-16

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. 31058      PMRA Submission No.       EPA Registration No.

Product Name: REGLONE ION

  • Active Ingredient(s)
    • DIQUAT

7. b) Type of formulation.

Application Information

8. Product was applied?

No

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.

Other

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 - Tingling skin

4. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 h

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

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.

Skin

11. What was the length of exposure?

<=15 min / <=15 min

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.)

1-45960889 - The reporter indicates a co-worker had an exposure to a pesticide containing the active ingredient diquat. On the day of the initial contact with the registrant, the reporter indicated his co-worker was exposed to the product after it leaked from the top of a container. Some of the concentrated product got onto a two centimeter area of the skin on his hand. The co-worker immediately rinsed the area with soap and water, but is experiencing tingling in the area. The reporter was advised that brief dermal contact might cause irritation, but a systemic toxicity is not anticipated from dermal contact on intact skin. The reporter was advised to have the co-worker to seek medical attention should the symptom persist. On follow-up one day later, the co-worker indicated the symptom lasted about six hours. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.