Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2023-5279
2. Registrant Information.
Registrant Reference Number: ProPharma Group case #: 2023SCPC00072425
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.
22-AUG-23
5. Location of incident.
Country: CANADA
Prov / State: UNKNOWN
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: GLYPHOSATE
7. b) Type of formulation.
Application Information
8. Product was applied?
No
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?
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: Male
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Skin
- Symptom - Inflammation of the skin
- Symptom - Lesion
- General
- Symptom - Neoplasia
- Symptom - Death
- Symptom - Cancer
- Specify - Mycosis fungoides lymphoma
4. How long did the symptoms last?
Persisted until death
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)
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.
Skin
11. What was the length of exposure?
>2 hrs <=8 hrs / >2 h <=8 h
12. Time between exposure and onset of symptoms.
>2 mos <=6 mos / > 2 mois < = 6 mois
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.)
2023SCPC00072425- The reporter, a member of the [Province] [Company], indicates an exposure to a pesticide containing the active ingredient glyphosate. Approximately two years before the day of initial contact with the registrant, the reporter indicated the patient was splashed on their face and forehead after handling a backpack tank with an improperly sealed lid. This was the first time the patient had used glyphosate and they did not wash their face for approximately 4 hours after exposure. Approximately two months after exposure the patient had a biopsy taken that found signs of inflammation but no signs of malignancy. Seven months after exposure a biopsy found a lesion in the patient's nose, and eight months after exposure the patient was diagnosed with mycosis fungoides lymphoma. Twenty months after exposure the patient passed away from complications of lymphoma. No additional information is available.
To be determined by Registrant
14. Severity classification.
Death
15. Provide supplemental information here.
The notes say that the deceased's physician is adamant that glyphosate caused the patient's cancer. The [Organization] is contesting the conclusion that glyphosate is the cause of the patient's cancer.