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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-4614

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 2023SCPU00071626

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.


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: ILLINOIS

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.       PMRA Submission No.       EPA Registration No. 100-1605

Product Name: MIRAVIS NEO

  • Active Ingredient(s)
      • Guarantee/concentration 9.3 %
      • Guarantee/concentration 11.6 %
      • Guarantee/concentration 7 %

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

Product Name: ENDIGO ZC

  • Active Ingredient(s)
      • Guarantee/concentration 9.48 %
      • Guarantee/concentration 12.6 %

7. b) Type of formulation.


Application Information

8. Product was applied?


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?


Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.


2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.


  • Nervous and Muscular Systems
    • Symptom - Other
    • Specify - Manic
    • Symptom - Other
    • Specify - Paranoid
    • Symptom - Other
    • Specify - Psychosis
    • Symptom - Other
    • Specify - Unable to communicate clearly
    • Symptom - Other
    • Specify - Paranoid delusions

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?


7. Exposure scenario


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

Pesticide Spill

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

10. Route(s) of exposure.


11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>8 hrs <=24 hrs / > 8 h < = 24 h

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.)

2023SCPU00071626- The reporter, a family member of the patient, indicates an exposure to a mixture of pesticides containing the active ingredients azoxystrobin, propiconazole, pydiflumetofen, lambda-cyhalothrin, and thiamethoxam. Seven days before the day of initial contact with the registrant, the reporter indicated the patient was sprayed with a diluted mixture of the products. They removed their contaminated clothing and showered shortly after exposure. The next morning the patient seemed manic and paranoid. Three days before the day of initial contact the patient was experiencing psychosis and was unable to communicate clearly. Two days before the day of initial contact the patient was experiencing paranoid delusions and was hospitalized in the psychiatric ward. The reporter was advised that the symptoms were not consistent with exposure to this pesticide and the patient should continue to receive symptomatic and supportive medical attention. On follow up calls one and four days after the day of initial contact, the patient was still hospitalized but seemed to be improving. The reporter indicated the medical staff do not think the product exposure was the cause of the symptoms. No additional information is available.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.