Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-5673

2. Registrant Information.

Registrant Reference Number: X

Registrant Name (Full Legal Name no abbreviations): X

Address: X

City: X

Prov / State: X

Country: X

Postal Code: X

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

04-OCT-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. 33237      PMRA Submission No.       EPA Registration No.

Product Name: STRIKE 85CP FUMIGANT

• Active Ingredient(s)
  • CHLOROPICRIN

---

7. b) Type of formulation.

Other (specify)

FUMIGANT

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: CHAMP DE POMMES DE TERRES

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

La region du Quebec du PCP a ete informee le 17 octobre 22 dun incident potentiel au cours duquel des citoyens auraient ete exposes a de la chloropicrine suite a une application du produit dans un champ de pommes de terres adjacent a leurs maisons. Le 4 octobre 2022 en soiree, un producteur de pommes de terres a applique le produit Strike 85 CP (#LPA 33237) dans un champ de la municipalite de [Ville], region de [Region]. Une seconde application aurait eu lieu dans un champ de la meme municipalite le 5 octobre, soit le lendemain de la premiere application. Le Ministère de lenvironnement du Quebec aurait deja contacte le producteur. Ce dernier indique avoir applique le produit correctement et ne pas comprendre ce qui sest passe. Update (December 9, 2022): The grower has a provincial certification for pesticide application. The grower had a fumigation plan. Update (March 30, 2023): L'ingredient actif est la chloropicrine. C'est un organochlore, qui cause des larmoiements, la gorge et les yeux qui piquent et des difficultes respiratoires. La zone tampon n'est que de 8m en compaction sans film, alors qu'avec film elle est plus complexe. Il faudrait reevaluer. Une inversion thermique et peu de vent, sont en cause.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Irritated eye
  • Symptom - Watery eye

• Respiratory System
  • Symptom - Sore throat

• Gastrointestinal System
  • Symptom - Vomiting

• Eye
  • Symptom - Itchy eye

• Respiratory System
  • Symptom - Itchy throat
  • Symptom - Difficulty Breathing

• Eye
  • Symptom - Tearing

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

Non-occupational

8. How did exposure occur? (Select all that apply)

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.)

Suite a ces applications, deux plaintes de citoyens habitant a proximite des champs traites ont ete faites aupres dUrgence Environnement, alleguant que ces derniers avaient ete exposes a la chloropicrine. Les symptomes declares, soient de lirritation oculaire avec larmoiements, mal de gorge et vomissements, seraient compatibles avec une exposition a la chloropicrine selon levaluation preliminaire faite par le medecin de garde a la Sante Publique de [Region]. Impossible de savoir pour le moment combien de personnes auraient ete incommodees, ni si ces expositions ont requis des soins ou hospitalisations. Dapres la Sante Publique, les personnes auraient ete exposees de la meme maniere l annee derniere, a la meme periode, suite a une application faite par le meme agriculteur dans ses champs. Les personnes exposees presentaient les memes symptomes l annee derniere. Update (March 30, 2023): Le 4 octobre 2022 en fin de journee une application de Strike 85 CP a ete faite et a occasionne des vomissements chez une personne qui habite pres du lieu d'application. Cette personne et quatre autres personnes ont ete incommodees: Larmoiements, gorge et yeux qui piquent, difficulte a respirer.

To be determined by Registrant

14. Severity classification.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Irritated eye
  • Symptom - Watery eye

• Respiratory System
  • Symptom - Sore throat

• Gastrointestinal System
  • Symptom - Vomiting

• Eye
  • Symptom - Itchy eye

• Respiratory System
  • Symptom - Itchy throat
  • Symptom - Difficulty Breathing

• Eye
  • Symptom - Tearing

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

Non-occupational

8. How did exposure occur? (Select all that apply)

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.)

Suite a ces applications, deux plaintes de citoyens habitant a proximite des champs traites ont ete faites aupres dUrgence Environnement, alleguant que ces derniers avaient ete exposes a la chloropicrine. Les symptomes declares, soient de lirritation oculaire avec larmoiements, mal de gorge et vomissements, seraient compatibles avec une exposition a la chloropicrine selon levaluation preliminaire faite par le medecin de garde a la Sante Publique de [Region]. Impossible de savoir pour le moment combien de personnes auraient ete incommodees, ni si ces expositions ont requis des soins ou hospitalisations. Dapres la Sante Publique, les personnes auraient ete exposees de la meme maniere l annee derniere, a la meme periode, suite a une application faite par le meme agriculteur dans ses champs. Les personnes exposees presentaient les memes symptomes l annee derniere. Update (March 30, 2023): Le 4 octobre 2022 en fin de journee une application de Strike 85 CP a ete faite et a occasionne des vomissements chez une personne qui habite pres du lieu d'application. Cette personne et quatre autres personnes ont ete incommodees: Larmoiements, gorge et yeux qui piquent, difficulte a respirer.

To be determined by Registrant

14. Severity classification.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Itchy eye
  • Symptom - Tearing

• Respiratory System
  • Symptom - Itchy throat
  • Symptom - Difficulty Breathing

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

Non-occupational

8. How did exposure occur? (Select all that apply)

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.)

Update (March 30, 2023): Le 4 octobre 2022 en fin de journee une application de Strike 85 CP a ete faite et a occasionne des vomissements chez une personne qui habite pres du lieu d'application. Cette personne et quatre autres personnes ont ete incommodees: Larmoiements, gorge et yeux qui piquent, difficulte a respirer.

To be determined by Registrant

14. Severity classification.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Tearing
  • Symptom - Itchy eye

• Respiratory System
  • Symptom - Itchy throat
  • Symptom - Difficulty Breathing

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

Non-occupational

8. How did exposure occur? (Select all that apply)

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.)

Update (March 30, 2023): Le 4 octobre 2022 en fin de journee une application de Strike 85 CP a ete faite et a occasionne des vomissements chez une personne qui habite pres du lieu d'application. Cette personne et quatre autres personnes ont ete incommodees: Larmoiements, gorge et yeux qui piquent, difficulte a respirer.

To be determined by Registrant

14. Severity classification.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Tearing
  • Symptom - Itchy eye

• Respiratory System
  • Symptom - Itchy throat
  • Symptom - Difficulty Breathing

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

Non-occupational

8. How did exposure occur? (Select all that apply)

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.)

Update (March 30, 2023): Le 4 octobre 2022 en fin de journee une application de Strike 85 CP a ete faite et a occasionne des vomissements chez une personne qui habite pres du lieu d'application. Cette personne et quatre autres personnes ont ete incommodees: Larmoiements, gorge et yeux qui piquent, difficulte a respirer.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.