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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-1011

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 2022SCPU00038311

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: DIQUAT TECHNICAL

• Active Ingredient(s)
  • DIQUAT
    • Guarantee/concentration 37 %

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: >6 <=12 yrs / > 6 < = 12 ans

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Nausea
  • Symptom - Vomiting
  • Symptom - Irritated throat

• Liver
  • Symptom - Elevated liver enzymes

• Gastrointestinal System
  • Symptom - Other
  • Specify - Black emesis

• Nervous and Muscular Systems
  • Symptom - Abnormal gait

• General
  • Symptom - Hyperthermia
  • Symptom - Other
  • Specify - Unable to make eye contact

• Nervous and Muscular Systems
  • Symptom - Bizarre behaviour
  • Symptom - Other
  • Specify - Abnormal head movements

• Blood
  • Symptom - Other
  • Specify - Abnormal renal values

• Cardiovascular System
  • Symptom - Other
  • Specify - Abnormal blood pressure readings
  • Symptom - Tachycardia

• Skin
  • Symptom - Pallor

• Nervous and Muscular Systems
  • Symptom - Ataxia

• Gastrointestinal System
  • Symptom - Diarrhea

• Respiratory System
  • Symptom - Other
  • Specify - Bilateral lung infiltrates
  • Symptom - Other
  • Specify - Rhinovirus

• Blood
  • Symptom - Hypoxemia

• General
  • Symptom - Fever
  • Symptom - Abnormal behaviour
  • Symptom - Loss of balance

• Cardiovascular System
  • Symptom - Other
  • Specify - Hemodynamically unstable

• Respiratory System
  • Symptom - Other
  • Specify - RSV

• Gastrointestinal System
  • Symptom - Other
  • Specify - Enterovirus
  • Symptom - Other
  • Specify - Thickening of the distal esophageal wall

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?

2

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.

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

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.)

2022SCPU00038311 - Acute diquat ingestion: probably responsible Scenario/Substances: An 8 y/o male drank a mouthful from a soda bottle, thinking it was soda. He experienced nausea, 5 vomiting episodes,and throat irritation between the time of ingestion and the time of presentation to the ED (within 3 hours). The ingested substance was initially unidentified. Physical Exam: BP 158/86, HR 130, O2 Sat, 100% on RA, T 37C.Laboratory/Diagnostic Findings: 1st ED visit: BUN 18, Cr 0.49, WBC18.2. 2nd ED visit: Na 135/K 3.6/Cl 108/CO2 13/BUN 33/Cr 3.22, AST 1,109,ALT 944, C-reactive protein 44.6 mg/L, WBC 28.9/Hgb 16.2/, Hct 48.8/PLT542. CSF protein 88 mg/dL. Clinical Course: The mother of the child had obtained the herbicide from a friend and decanted it into an unmarked soda bottle. At this time it was believed clopyralid was the active ingredient. The patient was observed, managed symptomatically, and discharged home that morning. He returned mid-afternoon the same day after 8 episodes of black emesis. Mother reported his T 40C. In the ED, the patient had abnormal behavior, an unsteady gait, abnormal head movements and was unable to make eye contact, although he was able to answer questions. The patient continued to decompensate and about 4 hours later,family informed providers that the substance ingested was actually an herbicide containing 37% diquat dibromide. BP 118/57, HR 173, RR 34,O2 sat 96% on 2L of O2. He was pale and ataxic, with episodes of diarrhea. He received APAP, ceftriaxone, morphine, prochlorperazine, lorazepam,NS bolus, and an H2-blocker. Head CT was unremarkable. He was admitted to the PICU. He was intubated on arrival and sedated with dexmedetomidine. He was started on NAC. T 39C despite application of a cooling blanket. Cr 3.9 and he was started on CRRT. Intermittent HD was attempted, but he became hemodynamically unstable and required initiation of vasopressors. The patients ventilation status worsened with O2 sat 87 on 100% FiO2. Pressors were increased with minimal improvement of BP. Respiratory viral screen returned positive for rhinovirus,enterovirus and RSV. Chest CT showed bilateral lung infiltrates and thickening of the distal esophageal wall. Stress dose steroids were administered. Lung function continued to worsen and he was started on nitric oxide for ARDS. Hemodynamics and oxygenation continued to worsen,and cyclophosphamide was administered. ECMO, lung transplantation was offered but the patient died despite aggressive resuscitative efforts later on Day 2.

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.