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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-3982

2. Registrant Information.

Registrant Reference Number: ProPharma Group# 2022SCPC00046969

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.

Packaging Failure

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

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. 33538      PMRA Submission No.       EPA Registration No. Unknown

Product Name: SIERRA 3.0 AG HERBICIDE

• Active Ingredient(s)
  • FLUCARBAZONE (PRESENT AS FLUCARBAZONE-SODIUM)

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 VI: Packaging Failure

1. What is the type of packaging that failed?

Unknown / Inconnu

2. Did packaging failure occur during?

Transportation

3. Did packaging failure result in?

potential exposure

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

2022SCPC00046969 The reporter describes a packaging failure involving a pesticide containing the active ingredient flucarbazone (present as flucarbazone-sodium). The reporter stated that on receipt of the pesticide containers it appeared the caps were improperly threaded on the bottle. When the containers were angled during removal from the pallet approximately one tablespoon of the pesticide leaked from each of the seven containers. No exposure or environmental injury took place. No further information is available.

For Registrant use only

5. Provide supplemental information here.