Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2022-4573
2. Registrant Information.
Registrant Reference Number: ProPharma Group case #: 2022SCPC00054605
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.
10-AUG-22
5. Location of incident.
Country: CANADA
Prov / State: SASKATCHEWAN
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.
Active(s)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. Unknown
Product Name: BRAVO
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
Site: Agricultural-Outdoor/Agricole-extérieur
Préciser le type: unknown
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: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
4. How long did the symptoms last?
>8 hrs <=24 hrs / > 8 h < = 24 h
5. Was medical treatment provided? Provide details in question 13.
Unknown
6. a) Was the person hospitalized?
Unknown
6. b) For how long?
7. Exposure scenario
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
Amount of time between application and contact 24
Hour(s) / Heure(s)
What was the activity? Re-entering field
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
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.)
2022SCPC00054605- The reporter, an employer, indicates an exposure to a pesticide containing the active ingredient chlorothalonil. An unknown amount of time before the day of initial contact with the registrant, the reporter indicated an employee re-entered a field where that product had been applied approximately 24 hours previously and the employee developed skin irritation an unknown amount of time later. The reporter indicated the employees skin irritation resolved within 24 hours. No additional information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
4. How long did the symptoms last?
Unknown / Inconnu
5. Was medical treatment provided? Provide details in question 13.
Unknown
6. a) Was the person hospitalized?
Unknown
6. b) For how long?
7. Exposure scenario
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
Amount of time between application and contact 24
Hour(s) / Heure(s)
What was the activity? Re-entering field
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
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.)
2022SCPC00054605- The reporter, an employer, indicates an exposure to a pesticide containing the active ingredient chlorothalonil. An unknown amount of time before the day of initial contact with the registrant, the reporter indicated an employee re-entered a field where that product had been applied approximately 24 hours previously and the employee developed skin irritation an unknown amount of time later. The reporter indicated the employees skin irritation had lessened, but not resolved. The reporter was advised to have the employee seek medical evaluation if the symptom persisted, but further symptoms were not anticipated. No additional information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
4. How long did the symptoms last?
>8 hrs <=24 hrs / > 8 h < = 24 h
5. Was medical treatment provided? Provide details in question 13.
Unknown
6. a) Was the person hospitalized?
Unknown
6. b) For how long?
7. Exposure scenario
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
Amount of time between application and contact 24
Hour(s) / Heure(s)
What was the activity? Re-entering field
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.
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.)
2022SCPC00054605- The reporter, an employer, indicates an exposure to a pesticide containing the active ingredient chlorothalonil. An unknown amount of time before the day of initial contact with the registrant, the reporter indicated an employee re-entered a field where that product had been applied approximately 24 hours previously and the employee developed eye irritation an unknown amount of time later. The reporter indicated the employees eye irritation had resolved within 24 hours. No additional information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
4. How long did the symptoms last?
Unknown / Inconnu
5. Was medical treatment provided? Provide details in question 13.
Unknown
6. a) Was the person hospitalized?
Unknown
6. b) For how long?
7. Exposure scenario
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
Amount of time between application and contact 24
Hour(s) / Heure(s)
What was the activity? Re-entering field
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.
Unknown
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.)
2022SCPC00054605- The reporter, an employer, indicates an exposure to a pesticide containing the active ingredient chlorothalonil. An unknown amount of time before the day of initial contact with the registrant, the reporter indicated an employee re-entered a field where that product had been applied approximately 24 hours previously and the employee developed a headache an unknown amount of time later. The reporter was advised the symptom did not indicate a toxicity; however medical evaluation should be sought if the symptoms did not resolve within 24 hours. No additional information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.