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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-1010

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 2022SCPU00038313

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: UNKNOWN

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: PARAQUAT TECHNICAL

• Active Ingredient(s)
  • PARAQUAT
    • Unknown

7. b) Type of formulation.

Liquid

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: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Nausea
  • Symptom - Vomiting

• Respiratory System
  • Symptom - Shortness of breath

• General
  • Symptom - Pain

• Cardiovascular System
  • Symptom - Tachycardia

• Respiratory System
  • Symptom - Tachypnea
  • Symptom - Laboured breathing

• Cardiovascular System
  • Symptom - Other
  • Specify - Sinus rhythm with nonspecific ST-T abnormalities

• General
  • Symptom - Sweating

• Gastrointestinal System
  • Symptom - Other
  • Specify - Dry mucous membranes
  • Symptom - Other
  • Specify - Abdominal tenderness in bilateral upper quadrants

• Nervous and Muscular Systems
  • Symptom - Unresponsive

• Cardiovascular System
  • Symptom - Cardiac arrest
  • Specify - Asystolic
  • Symptom - Other
  • Specify - Nonspecific IVCD with LAD

4. How long did the symptoms last?

Persisted until death

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

1

Day(s) / Jour(s)

7. Exposure scenario

Non-occupational

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

Poisoning from ingestion of the pesticide

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.

<=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.)

2022SCPU000383013 - Acute paraquat ingestion: undoubtedly responsible Scenario/Substances: A 60 y/o male ingested 16 oz. of undiluted paraquat in an attempt to harm himself after an argument. He experienced immediate nausea and vomiting without hematemesis, followed by shortness of breath and diffuse body pains. He was transported by air ambulance to the ED. Enroute, he was placed on 2L O2 by nasal cannula and given activated charcoal. Past Medical History: High blood pressure, dyslipidemia. Tobacco and alcohol use. Home medications unknown other than acetaminophen with codeine. Physical Exam: Sickly in appearance with tachycardia, tachypnea, and diaphoresis. Breathing was labored, but lungs sounds were clear bilaterally. Dry mucous membranes with abdominal tenderness in bilateral upper quadrants. Alert and oriented with a GCS of 15. BP 144/80, HR 96,RR 32, O2 sat 81% on RA, T 35.4C.Laboratory/Diagnostic Findings: Na 143/K 5.4/Cl 105/CO2 14/BUN 9/Cr1.14/Glu 119/AG 24, AST 37, ALT 77, bilirubin 0.41, INR 1.14, pro-BNP1,342, WBC 16.8/Hgb 15.9/Hct 49.3/PLT 242, ABG-pH 7.25/pCO2 36/pO257/HCO3 15.8/BE -10.5. Serum APAP, ethanol and salicylate not detected. ECG: Sinus rhythm with nonspecific ST-T abnormalities, nonspecific IVCD with LAD; HR 93, QRS 138, QTc 528. Clinical Course: In the ED, his supplemental O2 was removed, and he was started on prednisone and antioxidant therapies with IV NAC and vitamin C. He was admitted to the ICU. Based on the prognosis, the family opted for institution of comfort measures. About 7 h after ingestion,the patient became unresponsive, asystolic and died. Autopsy Findings: Not performed.

To be determined by Registrant

14. Severity classification.

Death

15. Provide supplemental information here.

The information for this report was received via an external publication and the summary provided here in Section 13 is directly as written by Gummin et al., 2021. Citation: David D. Gummin, James B. Mowry, Michael C. Beuhler, Daniel A. Spyker, Alvin C. Bronstein, Laura J. Rivers, Nathaniel P. T. Pham Julie Weber (2021) 2020 Annual Report of the American Association of Poison Control Centers National Poison Data System (NPDS): 38th Annual Report, Clinical Toxicology, 59:12, 1282-1501. The exact name of the product was not stated in the publication.