Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2024-2056
2. Registrant Information.
Registrant Reference Number: Rocky Mountain PC Case#: 6798118
Registrant Name (Full Legal Name no abbreviations): FMC of Canada Limited
Address: 6755 Mississauga Road, Suite 204
City: Mississauga
Prov / State: ON
Country: Canada
Postal Code: L5N 7Y2
3. Select the appropriate subform(s) for the incident.
Human
4. Date registrant was first informed of the incident.
11-MAY-24
5. Location of incident.
Country: CANADA
Prov / State: SASKATCHEWAN
6. Date incident was first observed.
11-MAY-24
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. 29167
PMRA Submission No.
EPA Registration No.
Product Name: EXPRESS DF
PMRA Registration No. 28573
PMRA Submission No.
EPA Registration No.
Product Name: Aim EC Herbicide
PMRA Registration No.
PMRA Submission No.
EPA Registration No. Unknown
Product Name: "Round Up"
- Active Ingredient(s)
- GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
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: Unknown
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Caller's son sprayed 3 herbicides on their farm. Dermal and inhalation exposure. Unknown specifics of application.
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
- Gastrointestinal System
- Symptom - Vomiting
- Symptom - Diarrhea
- Nervous and Muscular Systems
- Symptom - Numbness
- Symptom - Anxiety
4. How long did the symptoms last?
<=30 min / <=30 min
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
Non-occupational
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.
Skin
Respiratory
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.)
Per caller - We live on a farm, and my son has been spraying 3 different herbicides. He got some on his face and skin, I think some of the dust was blown into his face by the wind, and could have inhaled some. He was very anxious following this. Was feeling fine, then his arms and legs developed a numb feeling, then had diarrhea with emesis. I am not sure of the exact names of the products, I googled the number from online for herbicides and found this number. I don't have the bottles, so I am just giving you the information I do have. He showered and after he threw up his sx have resolved. He is currently asx.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.