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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-1012

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 2022SCPU00038315

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: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Vomiting

• Renal System
  • Symptom - Other
  • Specify - Elevated renal values

• Blood
  • Symptom - Hypoxemia
  • Symptom - Acidosis

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?

5

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 <=2 hrs / >30 min <=2 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.)

2022SCPU000383015 - Acute paraquat ingestion: undoubtedly responsible Scenario/substances: A 75 y/o male unintentionally ingested a mouthful of paraquat concentrate from a soda bottle. He developed vomiting 1 h later and presented to the ED 4.5 h from ingestion. Past Medical History: Glimepiride, simvastatin, amlodipine, lisinopril,spironolactone, hydrochlorothiazide, aspirin, and clopidogrel. Physical Exam: Alert and oriented; no distress. No mouth lesions or irritation. BP 156/56, HR 94, RR 16, T 36C, O2 sat 98% on RA. Laboratory/Diagnostic Findings: Na 139/K 3.5/Cl 106/CO2 19/BUN 23/Cr 1.4/Glu 207, AST 27, ALT 22, CK 77, troponin 0.012.Clinical Course: He was admitted and started on IV cyclophosphamide,IV methylprednisolone and antiemetics. Precautions were taken to ensure no supplemental oxygen was given. Day 2 he was making urine,alert and oriented with unremarkable vitals, O2 sat 93%. Day 3 Cr 6.2and O2 sat 91%. Day 4 he required intubation for hypoxemia and was placed on 100% oxygen. BUN 122, Cr 9.9, AST 299, ALT 443, troponin5.99. He became acidotic (peak lactate 5.9 mmol/L) and died early on Day 5.Autopsy Findings: Cause of death: paraquat ingestion. Manner of death: accidental.

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 in Section 13 is included 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.