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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-4143

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-61991397

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.

18-AUG-20

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

16-AUG-20

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).

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

  • Skin
    • Symptom - Irritated skin
    • Symptom - Inflammation of the skin
  • Eye
    • Symptom - Red eye
    • Symptom - Other
    • Specify - film on the eye
    • Symptom - Swollen eye

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?

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

Eye

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.)

1-61991397 - The reporter indicates an exposure to a pesticide containing the active ingredient diquat. Two days before the day of initial contact, the reporter indicated he was loading the concentrated pesticide onto a tractor when some of it splashed up into his face. The reporter stated he felt some dermal irritation immediately, briefly washed off the affected area, but continued working. One day before the day of initial contact, the report stated he woke up with a red eye and swollen skin around his eye. On the day of initial contact, the reporter indicated he woke with the eye swollen shut and a film on the surface of the eye. The reporter was advised to seek immediate medical evaluation of his symptoms, but the described exposure was not expected to cause permanent damage to the eye. The reporter was not available on follow-up call one day after the day of initial contact. On follow-up call two days after the day of initial contact, the reporter indicated he sought medical attention with the doctor stating the lower eyelid was affected. The reporter stated he received medication and his symptoms were improving. No additional information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.