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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-2444

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-61307822

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.


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: ALABAMA

6. Date incident was first observed.


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. 100-1091


  • Active Ingredient(s)
    • DIQUAT
      • Guarantee/concentration 37.3 %

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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

Site: Res. - Out Home / Rés - à l'

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?


Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.


2. Demographic information of data subject

Sex: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.


  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
  • Respiratory System
    • Symptom - Coughing
    • Symptom - Wheezing
  • General
    • Symptom - Swelling
  • Respiratory System
    • Symptom - Other
    • Specify - chemical pneumonitis
  • Nervous and Muscular Systems
    • Symptom - Bizarre behaviour
  • Blood
    • Symptom - Hyponatremia
  • Cardiovascular System
    • Symptom - Cardiac arrest
  • Respiratory System
    • Symptom - Respiratory failure

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?


7. Exposure scenario


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


9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


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.)

1-61307822 - The reporter indicates an exposure to a pesticide containing the active ingredient diquat. Eleven days before the day of initial contact with the registrant, the report and his father were applying the product to a pond when the father got about 1 tablespoon of the product on his hand. He washed it off right away and there were no cuts on the affected area. Later that evening, the father developed vomiting, diarrhea, and a bad cough. Seven days before the day of initial contact, the father sought medical care where he was diagnosed with chemical pneumonitis. Up to the day of initial contact the reporter's father also developed wheezing, severe swelling of feet and hand, and incoherent behavior. The reporter was instructed to immediately seek medical care for his father. The reporter was not available on follow-up call three days after the day of initial contact.On follow-up call four days after the day of initial contact, the reporter indicated his father had been hospitalized and found to have hyponatremia. The reporter stated his father went into cardiac and respiratory arrest during treatment and was placed on a ventilator but was in stable conditions since one day after the day of initial contact. The reporter indicated his father had been taken off the ventilator on the day of this follow-up call and was expected to be discharged the next week.On follow-up call eighteen days after the day of initial contact, the reporter stated his father had been discharged still on oxygen, but overall condition was improving. No additional information is available.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.