Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2024-6479

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: 3954888

Nom du titulaire (nom légal complet, aucune abbréviation): Bayer CropScience Inc.

Adresse: 160 Quarry Park Boulevard SE Suite 130

Ville: CALGARY

État: AB

Pays: Canada

Code postal /Zip: T2C 3G3

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.

Incident chez l'humain

4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

09-JUL-24

5. Lieu de l'incident.

Pays: CANADA

État: SASKATCHEWAN

6. Date de la première observation de l'incident.

09-JUL-24

Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

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ARLA No d'homologation 28359      ARLA No de la demande d'homologation       EPA No d'homologation.

Nom du produit: PROLINE 480 SC FOLIAR FUNGICIDE

• Matière active
  • PROTHIOCONAZOLE

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7. b) Type de formulation.

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?

Oui

9. Dose d'application.

Inconnu

10. Site d'application (choisir tout ce qui s'applique).

Site: Agricultural-Outdoor/Agricole-extérieur

Specify Type: Pasture

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?

Inconnu

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: Unknown / Inconnu

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Système gastro-intestinal
  • Symptôme - Autre
  • Specify - Throat tightening

• Système respiratoire
  • Symptôme - Toux

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Inconnu

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Quelle était l'activité? Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding the activity

Dérive du pesticide à partir de la zone traitée

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Aucun

10. Voie(s) d'exposition.

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

7/9/2024 All of the following was spontaneously reported by the caller. Caller states that her neighbor sprayed a fungicide on a windy day and it spread all over her 40 acres of pasture. She is asking if her livestock will be ok to go back into the pasture and what she might expect from this- for her and her livestock. She states her friend had respiratory issues and had to leave the area. Caller could not confirm product. 7/10/2024 Caller inquiring on the safety of overspray of PROLINE 480 SC FOLIAR FUNGICIDE with regards to horses and pastures, birds, etcetera, on a wildlife nature preserve labeled as organic by the county. Product confirmed by the company during a callback as caller was not initially provided that information. Caller inquiring on the spray rate recommended for this product from an airplane or a helicopter as she believes it was incorrectly applied due to overspray. 7/10/2024 Addendum to Call 1: Caller reports her property was sprayed by over spray, 40 acres per jug. She states her livestock and her pasture were sprayed. She is asking when her livestock can go back on the pasture. Caller stated she was not physically there when this occurred. She then added that her own contractor who was physically there, had to shut down due to developing throat tightening and coughing. She stated she was not sure how this fungicide could affect her horses health if she has to go to a lawyer but knows the company is good at supporting people when their products are misused. Caller then decided to end the call so she could make further calls to identify the product correctly and would call us back. Additional notes from call on 7/9/2024: Caller stated the licensed contractor company who sprayed the product was (company name redacted) at (phone number redacted). She gave the contractor's name as (contractor's name redacted). She states the property where this was sprayed was (Redacted) property located in the Rural Municipality of [Municipality] in the province of Saskatchewan.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Narrative, continued: She lives next to this property where the over spray drifted. She stated she is south of them and id drifted two quarters. She stated it happened today in the morning, and is very windy out. She confirms her horses and her pastures was sprayed. She adds that the horses in her pasture are owned by other people and would like information e-mailed to her so she can provide to them if they have follow up questions about the incident. She is also asking for information to be e-mailed to her to give to her neighbors beside her and behind her. She asks about the suggested wind rate for application and if this is supposed to be sprayed by a helicopter. She comments saying thank you making a safe product and helping me. She further comments that the application of this is in question. She also had contractor workers on her property who were working for her, working there that got sprayed and are having problems. She did not provide further information on the workers. She again asks for information to be e-mailed to her so she can have it ready if needed for the workers. Since the helicopter company was not helpful in providing her information she comments not knowing if she needs to take this further. The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: Unknown / Inconnu

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Système respiratoire
  • Symptôme - Autre
  • Specify - Respiratory issues

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Inconnu

6. b) Pendant combien de temps?

7. Scénario d'exposition

Non professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Quelle était l'activité? Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding the activity

Dérive du pesticide à partir de la zone traitée

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Aucun

10. Voie(s) d'exposition.

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

7/9/2024 All of the following was spontaneously reported by the caller. Caller states that her neighbor sprayed a fungicide on a windy day and it spread all over her 40 acres of pasture. She is asking if her livestock will be ok to go back into the pasture and what she might expect from this- for her and her livestock. She states her friend had respiratory issues and had to leave the area. Caller could not confirm product. 7/10/2024 Caller inquiring on the safety of overspray of PROLINE 480 SC FOLIAR FUNGICIDE with regards to horses and pastures, birds, etcetera, on a wildlife nature preserve labeled as organic by the county. Product confirmed by the company during a callback as caller was not initially provided that information. Caller inquiring on the spray rate recommended for this product from an airplane or a helicopter as she believes it was incorrectly applied due to overspray. 7/10/2024 Addendum to Call 1: Caller reports her property was sprayed by over spray, 40 acres per jug. She states her livestock and her pasture were sprayed. She is asking when her livestock can go back on the pasture. Caller stated she was not physically there when this occurred. She then added that her own contractor who was physically there, had to shut down due to developing throat tightening and coughing. She stated she was not sure how this fungicide could affect her horses health if she has to go to a lawyer but knows the company is good at supporting people when their products are misused. Caller then decided to end the call so she could make further calls to identify the product correctly and would call us back. Additional notes from call on 7/9/2024: Caller stated the licensed contractor company who sprayed the product was (redacted) at (redacted). She gave the contractor's name as (redacted). She states the property where this was sprayed was (Redacted) property located in the Rural Municipality of [Municipality] in the province of Saskatchewan.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Narrative, continued: She lives next to this property where the over spray drifted. She stated she is south of them and id drifted two quarters. She stated it happened today in the morning, and is very windy out. She confirms her horses and her pastures was sprayed. She adds that the horses in her pasture are owned by other people and would like information e-mailed to her so she can provide to them if they have follow up questions about the incident. She is also asking for information to be e-mailed to her to give to her neighbors beside her and behind her. She asks about the suggested wind rate for application and if this is supposed to be sprayed by a helicopter. She comments saying thank you making a safe product and helping me. She further comments that the application of this is in question. She also had contractor workers on her property who were working for her, working there that got sprayed and are having problems. She did not provide further information on the workers. She again asks for information to be e-mailed to her so she can have it ready if needed for the workers. Since the helicopter company was not helpful in providing her information she comments not knowing if she needs to take this further. The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.