Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2022-5123
2. Registrant Information.
Registrant Reference Number: Rocky Mountain PC Case#: 6593037
Registrant Name (Full Legal Name no abbreviations): FMC Corporation
Address: 2929 Walnut Street
City: Philadelphia
Prov / State: Pennsylvania
Country: USA
Postal Code: 19104
3. Select the appropriate subform(s) for the incident.
Human
4. Date registrant was first informed of the incident.
14-SEP-22
5. Location of incident.
Country: CANADA
Prov / State: QUEBEC
6. Date incident was first observed.
14-SEP-22
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. 28982
PMRA Submission No.
EPA Registration No.
Product Name: Coragen
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: Lettuce
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Caller is an agricultural technician and entered a field today that had Coragen applied. He just got back.He went there noon 45. Want to know what measures he can take because he feels that he entered the field too soon.He was there for less than an hour. There was no windHe was checking on lettuce and had to check under the leaves. Maybe some dust. No particular exposure.He says that maybe he is tired but that he also just came from workHe understands that a person could have a reaction that is delayed What is someone ate the leaves of the lettuce. He did eat a lettuce leaf.
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.
Data Subject
2. Demographic information of data subject
Sex: Male
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.
No
6. a) Was the person hospitalized?
No
6. b) For how long?
7. Exposure scenario
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Walked into field, ate a lettuce leaf
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
Oral
11. What was the length of exposure?
>15 min <=2 hrs / >15 min <=2 h
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.)
Caller is an agricultural technician and entered a field today that had Coragen applied. He just got back.He went there noon 45. Want to know what measures he can take because he feels that he entered the field too soon.He was there for less than an hour. There was no windHe was checking on lettuce and had to check under the leaves. Maybe some dust. No particular exposure.He says that maybe he is tired but that he also just came from workHe understands that a person could have a reaction that is delayed What is someone ate the leaves of the lettuce. He did eat a lettuce leaf.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Caller is vague and hard to pin down on his symptoms. Maybe the skin is different - do not see anything particular. Maybe his eye lids are a little red as if a small sunburn and maybe his back but can not see his back.