Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-2341

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 2023SCPC00067672

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.

09-MAY-23

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

08-MAY-23

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)

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PMRA Registration No. 31408      PMRA Submission No.       EPA Registration No. Unknown

Product Name: VIBRANCE QUATTRO

• Active Ingredient(s)
  • DIFENOCONAZOLE
  • FLUDIOXONIL
  • METALAXYL-M AND S-ISOMER
  • SEDAXANE

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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: Unknown / Inconnu

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.

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

• Eye
  • Symptom - Red eye

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Unknown

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

Application

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.

<=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.)

2023SCPC00067672- The reporter indicates an exposure to a pesticide containing the active ingredients sedaxane, metalaxyl-m and s-isomer, difenoconazole and fludioxonil. The day before the day of initial contact with the registrant, the reporter indicated they were using the diluted product and immediately following application they noticed one of their eyes was red. The caller flushed their eyes for 20 minutes and consulted his eye doctor. On follow up call two days after the day of initial contact the reporter indicated they were evaluated by their eye doctor and the symptom was improving but not fully resolved. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.