UNITED STATES ENVIRONMENTAL PROTECTION AGENCY 

WASHINGTON, D.C. 20460 

OFFICE OF CHEMICAL SAFETY AND 

POLLUTION PREVENTION 

MEMORANDUM 

Date: May 21,2014 

SUBJECT: Paraquat Dichloride: Review of Human Ingestion Incidents 

PC Code: 061601 DP Barcode: 0420296 

Decision No.: 491188 

Petition No.: NA 

Risk Assessment Type: NA 

TXRNo.: NA 

MRID No.: NA 

Registration No.: NA 

Regulatory Action: NA 

Case No.: NA 

CAS No.: 72963-72-5 

40CFR: NA 

Ver.Apr.08 

FROM: Elizabeth Evans, Environmental Protection Specialist , _ ) 

Toxico

Health 

l

Effects 

ogy and 

Di

Epidemiolo

vision (7509P) 

gy Branch 

/1 ?:1;;. 

~~ 

/. I,.,;; ·11 I, / ' •'J /.1. l..;/J 

THROUGH: David J. Miller, Acting Branch Chief[ .._flj ~ ~ ·I& 

TO: 

Toxicology and Epidemiology Branch 

Health Effects Division (7509P) 

Elissa Reaves, Branch Chief 

Risk Assessment Branch IV 

Health Effects Division (7509P) 

Molly Clayton, Chemical Review Manager 

Risk Management & Implementation Branch III 

Pesticide Re-Evaluation Division (7508P) 

Summary and Conclusions 

Three deaths due to accidental ingestion of paraquat dichloride, occurring in the Central Valley 

of California, were brought to the attention of EPA by the Director of the California Poison 

Control System in a June 27, 2013 letter to EPA's Office of Pesticide Programs.' HED was 

requested by PRD to review its in-house and external incident databases. As part ofthis review, 

1 Dr. Gellar also notified the U.S. Consumer Product Safety Commission, who in forwarded the incident information 

on the three ingestion deaths and one major severity ingestion to Norman Spurling for input into IDS. 

l i P age 
2 | P a g e

several additional fatality reports involving paraquat dichloride ingestions were identified . Two 

of these subsequently identified deaths occurred in children, including a 15-month old who drank 

Gramoxone from a Gatorade bottle and an 8 year old who drank the product from a Dr. Pepper 

bottle. 

Fatalities from paraquat dichloride ingestion and high severity ingestion cases are the focus of 

this review which was requested by PRD to determine if there is a potential risk of concern for 

which mitigation actions might be considered. 

I. ACTION REQUESTED

On 6/27/13, EPA/OPP received a letter from Dr. Richard Geller, Director of the California 

Poison Control System (CPCS). Dr. Geller provided case details for three fatal and one severe

paraquat ingestion incidents that have occurred in the San Joaquin Valley of California in recent 

years, all resultant from accidental ingestion of paraquat that had been illegally repackaged into 

beverage containers. The letter also cites an additional nine serious poisonings (including eight 

fatalities) from paraquat and diquat. Dr. Geller’s letter includes the following request:

“These deaths, I believe with good reason, could have been prevented through reformulation of paraquat in a more 

dilute product.

 Syngenta markets 3 Gramoxone products in the US, all of which contain paraquat dichloride in a 30.1% 

formulation. These are: Gramoxone Inteon (EPA Reg. No. 100-1217), Gramoxone SL (EPA Reg. No. 100-1217), 

and Gramoxone SL 2.0 (EPA Reg. No. 100-1431). 

An accidental gulp of paraquat of say, 15 mL of the 30% product, would contain 4.5 grams of paraquat. A 

dose of 40 mg per kg, 2.8 grams in a 70 kg man, is widely considered to be fatal, while doses of less than 20 mg per 

kg, 1.4 grams in a 70 kg man, are much more likely to survive.

 For safety reasons, paraquat in Japan is formulated in a 5% solution. A swallow of 15 mL thus results in an 

ingestion of only .75 grams, or 10.7 mg/kg in a 70 kg individual. This is a survivable ingestion. Even 30 ml of a 5% 

solution, 21.4 mg/kg, is more likely than not to survive.

 I am writing to you because I believe that reformulation of Gramoxone to the Japanese standard could save 

lives here in the US. This change, made in Japan in the 1980s, is credited with significantly decreasing the number 

of paraquat fatalities there. The following are vignettes of the 4 cases of accidental ingestion leading to fatality2 we 

have seen at the Fresno/Madera Division of the California Poison Control System. We also have seen 9 other 

serious poisonings from paraquat and diquat with 8 fatalities, but these were deliberate ingestions/injections.”

As part of an OPP effort to investigate this request, HED performed this incident review of 

paraquat ingestion cases. For the purposes of this review, OPP’s Incident Data System (IDS), 

the Centers for Disease Control and Prevention/National Institute for Occupational Safety and 

Health (CDC/NIOSH) Sentinel Event Notification System for Occupational Risk (SENSOR)-

Pesticides, National Pesticide Information Center (NPIC), and the California Department of 

Pesticide Regulation (CDPR) Pesticide Illness Surveillance Program (PISP) databases were 

queried. These queries were conducted to confirm that the reports from CPCS are included in 

IDS, search for case matches across databases, and review additional ingestion incidents. Only

 

2 Three of the four case reports are fatalities, but the fourth one appears to be a non-fatal, high-severity case
3 | P a g e

those cases occurring in the United States were considered in this analysis. Paraquat dichloride 

is widely used globally, poisonings result in a high pesticide mortality rate3, and it is known to be 

a common agent for suicide.4 

While this report focuses on ingestion of paraquat dichloride, it also summarizes all paraquat 

dichloride incidents identified in IDS and provides some information regarding occupational 

incidents as well. 

II. BACKGROUND

Paraquat dichloride is an herbicide registered to control weeds and grasses in many agricultural 

and non-agricultural (e.g., Rights-of-Way) use sites. Tolerances are currently established for 

crop and livestock food commodities. Paraquat dichloride is also applied as a pre-harvest 

desiccation treatment on some crops including cotton. There are no products registered for 

homeowner use and no products registered for application to residential areas. (Paraquat 

Dichloride Final Work Plan, Docket # EPA-HQ-OPP-2011-0855)

Paraquat dichloride was first registered as a pesticide in the United States in 1964. In the 1960s 

and 1970s there were a number of fatalities from accidental swallowing of paraquat. In 1988 the 

registrants added “safening”5agents into all of its paraquat formulations to avoid accidental 

ingestion and to deter misuse. These measures included the addition of blue dye, an alerting 

agent (deterring odor), and an emetic. Prior to this, paraquat dichloride was brown in color like 

many cola beverages. The 1997 Paraquat Dichloride RED states that since these “safening” 

agents were added, “ U.S. Poison Control Center data show a decline of almost 50% when 

comparing the proportion of all pesticide exposure due to paraquat ingestion for the four years 

pre- and post-1988.”

6

Gramoxone Inteon (EPA Reg. No. 100-1217) was a formulation developed to decrease the acute 

oral toxicity in the event of ingestion by humans. Gramoxone Inteon ("Inteon" technology) 

included a “gelling” agent designed to reduce absorption of paraquat dichloride into the plasma 

following oral ingestion. However, this gelling agent did not prove successful in saving lives 

and has since been removed from the subsequent product Gramoxone SL.

All paraquat dichloride products are classified as Restricted Use Products (RUP); meaning that a 

certified pesticide applicator must apply or supervise the application of the product. Further, the 

product labels clearly and prominently prohibit pouring paraquat dichloride into food or 

beverage containers via the statement “NEVER PUT INTO FOOD, DRINK OR OTHER 

CONTAINERS” and “DO NOT REMOVE CONTENTS EXCEPT FOR IMMEDIATE USE.” 

 

3 Sittipunt, C. Teaching Case of the Month: Paraquat Poisoning. Respiratory Care, March 2005; Vol. 50 No. 3; 383-

385.

4 Nagami, H. et al, Paraquat Poisoning in Japan: A Hospital-based Survey. J Rural Med 2007; 2: 85-92.

5 Found on the Syngenta-sponsored Paraquat information website: 

http://paraquat.com/faq/accidental-ingestion/q-what-has-been-done-to-prevent-accidental-swallowing-of-paraquat

6 EPA Paraquat Dichloride Registration Eligibility Decision (RED). EPA 738-F-96-018. Found online at: 

http://www.epa.gov/oppsrrd1/REDs/0262red.pdf
4 | P a g e

According to Poisoning and Overdose, 6th edition Chapter 122. Paraquat and Diquat: “Ingestion 

of more than 40 mg/kg (~14 mL of a 20% solution in an adult) leads to corrosive GI injury, rapid 

onset of renal failure, myonecrosis, shock, and death within hours to a few days. Ingestion of 

20-40 mg/kg causes a more indolent course evolving over several days, with most patients dying 

of pulmonary fibrosis after days to weeks. Patients with ingestions of less than 20 mg/kg usually 

recover fully.”

The mitigation actions required by the 1997 RED were specifically intended to lessen the 

occupational and ecological risks posed by paraquat and included: a reduction in maximum 

application rates; additional PPE for mixers and loaders; reduction of paraquat concentration in 

backpack sprayers; and spray drift control measures. 

In the 2011 Paraquat Dichloride Docket # EPA-HQ-OPP-2011-0855, the Human Health Risk 

Scoping Document focused on inhalation exposure scenarios for registered uses, including 

occupational handler scenarios and residential bystander inhalation risk from off-target drift. 

Human incidents were reviewed and a moderately high frequency of incidents was found. 

III. RESULTS/DISCUSSION

For the purposes of this review, OPP’s Incident Data System (IDS), Sentinel Event Notification 

System for Occupational Risk (SENSOR)-Pesticides, National Pesticide Information Center 

(NPIC), and CDPR’s Pesticide Illness Surveillance Program (PISP) databases were queried. The 

queries were conducted to confirm the reports from California Poison Control System were 

included in IDS, search for case matches across databases, and review additional ingestion 

incidents. Only those cases occurring in the United States were considered in this analysis. This 

analysis is limited to paraquat dichloride (pc code 061601) as with the previous Human Incident 

Review memo from 2009.7 

a. IDS (Incident Data System)

OPP’s IDS includes reports of alleged human health incidents from various sources, including 

mandatory Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) Section 6(a)(2) reports 

from registrants, other federal and state health and environmental agencies, and individual 

consumers. Since 1992, OPP has compiled these reports in IDS. IDS contains reports from 

across the United States, and most incidents have all relevant product information recorded. 

Reports submitted to the IDS represent anecdotal reports or allegations only, unless otherwise 

stated in the report. 

IDS records incidents in one of two modules: Main IDS and Aggregate IDS:

 

o Main IDS contains incidents resulting in higher severity outcomes and provides 

more detail with regard to case specifics. This system stores incident data for 

death, major and moderate incidents, and it includes information about the 

 

7

Paraquat (pc code 061603) has been cancelled and cases are not included.
5 | P a g e

location, date and nature of the incident. Main IDS incidents involving only one 

active ingredient (as opposed to pesticide products with multiple active 

ingredients) are considered to provide more certain information about the 

potential effects of exposure from the pesticide. 

o Aggregate IDS contains incidents resulting in less severe human incidents (minor, 

unknown, or no effects outcomes). These are reported by registrants only as 

counts in what are aggregate summaries. 

A query of (United States only) Main IDS from for all available years identifies a total of 276

incidents involving paraquat dichloride. A query of Aggregate IDS identifies a total of 342 

incidents involving paraquat dichloride (Aggregate IDS cases do not include case descriptions 

and are not analyzed in this report). 

Overall paraquat incident count information in IDS

Severity Code Severity

Main 

IDS Aggregate IDS Total

HA Death 27 27

HB Major 22 22

HC Moderate 181 181

HD Minor 26 326 352

HE human exposure 5 16 21

H human exposure 15 15

H-A (death): If the person died; 

H-B (major): If the person alleged or exhibited symptoms which may have been life-threatening, 

or resulted in adverse reproductive effects or in residual disability; and

H-C (moderate): If the person alleged or exhibited symptoms more pronounced, more prolonged 

or of a more systemic nature than minor symptoms, usually some form of treatment of the person 

would have been indicated, symptoms were not life threatening and the person has returned to 

his/her pre-exposure state of health with no additional residual disability. 

H-D (minor): If the person alleged or exhibited some symptoms, but they were minimally 

traumatic, the symptoms resolved rapidly and usually involve skin, eye or respiratory irritation; 

and

H-E/H (unknown or no effects): If symptoms are unknown, unspecified or are alleged to be of a 

delayed or chronic nature that may appear in the future.

For the purposes of this special report, deaths (HA) and high severity outcomes (HB) were 

analyzed in Main IDS. Additionally, (HC) moderate severity health outcomes reported to Main 

IDS since 2010 were reviewed.

A query of Main IDS from 1990- February 2014, covering 24 years (all available years),

identifies 27 deaths involving paraquat dichloride. Three fatalities match the three fatalities

reported by Dr. Gellar from California Poison Control System; the fourth case reported by Dr. 

Gellar is coded as “high” severity in Main IDS. 
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Paraquat dichloride fatalities in Main IDS

27 deaths involving paraquat dichloride were reported to Main IDS over the 24-year period from 

1990-February 2014:

 22 death reports involved ingestion of paraquat dichloride

o 11 deaths were from intentional ingestion. 

o Eight deaths were due to the accidental ingestion of paraquat dichloride; all of 

these involved ingestion out of a reused beverage container containing the 

chemical

o Three paraquat ingestion deaths were unclear as to whether they were intentional 

or unintentional 

 Two deaths from one incident (010677-00001) appear to be related to a drift event in 

which the farmer mistook Gramoxone for 2,4-D.

 Three deaths had unclear or unknown exposure circumstances

Table 1 describes seven accidental ingestion deaths reported in Main IDS. Table A-1 in 

Appendix A contains the full Main IDS table of all 27 reported deaths.

Table 1. Accidental Ingestion Deaths involving Paraquat Dichloride (pc code 061601)

Reported to Main IDS 1990-February 2014

Case ID Year Description

1 010077-00001 2000 15 month old child ingested paraquat product in a Gatorade container. Acute 

renal failure, nitric oxide used, sepsis set in and the child died

2 013569-00001 2002 Man ingested gulp of paraquat from Pepsi bottle. Was put on ventilator, 

given renal dialysis. Died.

3 014885-00026 2003 Adult male was making an application of paraquat to his yard. He had two 

coffee cups in his garage, one contained coffee and the other contained 

paraquat. He accidentally took a sip of the paraquat and immediately spit it 

out. About an hour later he started to feel sick and drove himself to the 

hospital. His condition progressively got worse and he died on March 12, 

2003. The cause of death established by the coroner was acute paraquat 

intoxication and multiple organ failure.

4 016310-00001 2005 48 yr. old man was apparently transferring straight product from a glass jar to 

a sprayer. He reportedly drank from that container by accident. He thought 

he’d consumed tobacco spittle, so he didn’t seek medical attention 

immediately for the vomiting noted shortly afterward, according to the 

brother. Tested for drugs, apparently. Had been going through alcohol 

withdrawal according to brother. Never any mention of a suicide attempt.

5 025332-00001 2013 70 yr. old female ingested some contents of a re-used iced tea bottle, which 

unknown to her contained Gramoxone. She presented awake and alert with 

persistent vomiting. Over the course of a 16 day admission she evolved the 

classic picture of paraquat ingestion: corrosive gastrointestinal injury plus 

renal and pulmonary failure leading to death. 

6 013372-00001 2002 The circumstances of exposure are unclear. On 10/2/02, caller indicated 

woman drank sips of paraquat by accident as she reached for her coffee. On 

10/4/02, the history was altered, “During the night the patient got up to get 

some cough medicine which was sitting next to the product and took product 

by mistake”.
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7 025332-002

(update to 

021704-00006)

2010 A 44 year old male mistakenly drank the product and developed difficulty in 

breathing and vomiting of blood. He was admitted to the intensive care unit.

Perished

8 016630-00001 2005 Man drank paraquat & organophosphates out of a bottle. Intubated at hospital, 

significant respiratory symptoms, blue sweat and urine. Accidental ingestion.

Perished

High Severity Paraquat cases in Main IDS

A query of Main IDS over the 24-year period from 1990- February 2014 identifies 22 major 

severity paraquat dichloride incidents: 

 Four major severity cases were due to accidental ingestions. 

 Nine cases were occupational incidents; generally dermal exposures.

 One case was a suicidal ingestion.

 One case related to bystander drift has a lawsuit pending.

 Seven cases are unclear or case descriptions were not found.

Table 2 describes the four major severity accidental ingestions. Table 3 summarizes the nine 

occupational major severity incidents. 

Table 2. Major Severity Accidental Ingestion Cases involving Paraquat Dichloride (pc code 061601)

Reported to Main IDS 1990-February 2014

Case ID Year Description

1 017507-00015

2006 A 27 year old man, ingested 4 oz of product (43% solution). He developed 

burning sensation in his chest and mouth; he also vomited several times. At the 

hospital esophagogastroduodenoscopy was done and found ulcerations in the 

esophagus, stomach and proximal duodenum. He was discharged after 24 hours. 

He returned to the ER, 4 days later with shortness of breath and hemoptysis 

(coughing blood). Chest X-ray showed bilateral lung infiltrates. A serum and 

urine paraquat level four days after the ingestion was 0.08 mcg/ml (normal 

<0.06 mcg/ml), and 0.76 mcg/ml (asymptomatic sprayers up to 0.3 mcg/ml) 

respectively. He was given methylprednisolone, dexamethasone, 

cyclophosphamide, acetylcysteine, vitamin C, vitaminE, Rapamycin and 

antibiotics. He was put on hemodialysis for 6 days for kidney failure. He was 

transfered to the inpatient psychiatric ward after 39 days with residual lung and 

kidney symptoms.

2 018939-00013 2007 A 52 year old male ingested about 60 ml of paraquat (30 ml of 43.8% paraquat 

and 30 ml of water). Gastric lavage was performed about 1.5 hours postingestion. However, he developed impaired lung, liver and kidney functions. 

He was put on hemoperfusion, and later received hemodialysis. He was also 

given cyclophosphamide and methylprednisolone. Serum paraquat level was 

0.79 mcg/ml at about 4 hours after ingestion. He was transferred to the 

psychiatric unit about 2 weeks after the admission.

3 020720-00027 2009 A 53 year old female accidentally ingested the product (about 1-2 teaspoon) 

which was placed in the water bottle. She developed oral swelling and was 

admitted to the intensive care unit. Paraquat level at 22 hours post-ingestion was 

0.038mcg/ml; liver enzymes levels were also increased. Paraquat was not 

detected in the urine sample collected 4 days post-ingestion. She was intubated 

and put on dialysis machine for few days. She was discharged from the hospital 

after 3 weeks.
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4 021194-00005 2009 A 49 year old male stated that he got the product accidentally in his mouth 

while using it, and developed swollen lips, tongue and ulcers in his mouth. He 

was admitted to the ICU; found ulcers also in the esophagus. He was discharged 

from the hospital after few days.

Table 3. Major Severity Occupational Cases involving Paraquat Dichloride (pc code 061601)

Reported to Main IDS 1990-February 2014

Case ID Year Description

1 007791 - 00014 1998

An adult male was using 1% product in a backpack sprayer 3 days ago and fell 

during use causing him to get solution on his arm. He was not able to wash for 

about an hour. No irritation, noted that day some difficulty using that arm.

2 010749 - 00004 2000 Heart problems

3 013857 - 00018 2002

Caller is wife who states that husband was in field and exposed to product. 

Then spoke with patient (husband) who says he sprayed product on Nov 6th of 

‘02. Says that he went out about 2-3 weeks later in field with cut on foot. Says 

that at beginning of new year he had some issues with the foot and problems 

that MD diagnosed. Wife of man afflicted called back. Says he has lost part of 

his foot due to this product. Wants medical expenses paid for by rancher boss. 

4 015485 - 00013 2004

Two male workers- one Hispanic and Spanish-speaking, the other an African 

American with limited literacy skills - were applying product one week prior to 

coming to the HCF 5 days ago. The wind was high and variable, so there were 

frequent dermal and inhalational exposures to product during the course of 

application. Dilution of product is not known and is difficult to determine given 

the communication limitations. Length of exposure was extended, but not 

exactly defined. The Hispanic male is more symptomatic, but both have had 

considerable respiratory, renal and Hepatic symptoms. The Hispanic male has 

received steroid and NAC therapies. The African American male had been 

receiving supplemental care 

5 017862 - 00006 2005

A 56 year old male stated that he developed shortness of breath, pain in chest/ 

shoulders/ neck, low fever and rapid heart rate after using the product. He was 

admitted to the hospital for 18 days. He used the product again this year and 

came down with same symptoms; lab results showed, WBC was 15,000 and 

erythrocyte sedimentation rate was 97 (normal 15-20). However, physicians 

were unable to find the cause of his symptoms.

6 018939 - 00008 2006

Adult (18-64) year old male stated that the product accidentally spilled on his 

hands several times, while using it at work. He stated that he developed dry and 

flaky skin on hands, and flakey fingernails.

7 021807 - 00004 1990

Caller has questions about intermittent, recurring exposure to Gramoxone 

products over the last many years. His last exposure to the product would have 

been to a mist of diluted product in April or May of 2009. He merely reports 

that he's been a little careless, with occasional dermal exposure to product mists 

on skin only, no ingestions. His symptoms started last year-- nausea, dizziness, 

off balance, not sleeping as well. He originally asked his MDs if these might be 

side effects of medications that he takes, and his doctors don't think so. He had 

his bladder removed due to cancer in the past. Since then, his doctors monitor 

his lungs and kidneys regularly and haven't reported any issues to him. He's just 

looking for more info on the Gramoxone.

8 022354 - 00006 2010

Adult (16-64) year old worker, accidentally spilled the product 

(concentration,50/50) on his stomach and genital areas. He was admitted to the 

Burn Center, and he received a skin transplant. 

9 023072 - 00184 2011

Adult male was pouring Gramoxone into a sprayer and some of the Gramoxone 

spilled under his arm. This happened about 10:30 Thursday morning June 9. He 
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did not change clothes and shower until that night. He didn't start feeling any 

symptoms until the next day around lunch. He noticed red sunburn like circle 

under his arm about 3 inches in diameter. On Saturday the area got worse. It 

was about 5 to 6 inches in diameter and turned a reddish purple color. On 

Saturday evening the blisters started to form. On Sunday the area affected 

continued to get larger. He said it was about 4 inches wide and 8 inches long 

and the blisters became worse. This is when he had a doctor look at it. The local 

doctor recommended that he go to the bum center in Augusta, Georgia on 

Monday. He was diagnosed with second degree bums and treated. The Poison 

Control Center was contacted (but not Syngenta or Prosar). He is scheduled to 

go back to Augusta next Tuesday to have the area checked. He said they put 

some cadaver skin on the area on Monday and they are going to check it to see 

if they will have to do some skin grafting.

Moderate Severity Paraquat Cases in IDS

A query of Main IDS from 1990-February 2014 identifies a total of 181 moderate severity 

paraquat dichloride cases. For the purposes of this review, moderate severity incidents from 

2010-2013, a total of 35 incidents, were analyzed in detail and are summarized in the Table 

below. Moderate severity (HC) incidents in Main IDS are defined as follows: If the person 

alleged or exhibited symptoms more pronounced, more prolonged or of a more systemic nature 

than minor symptoms, usually some form of treatment of the person would have been indicated, 

symptoms were not life threatening and the person has returned to his/her pre-exposure state of 

health with no additional residual disability. 

All but one of the moderate severity incidents from 2010 -2013 involved a Gramoxone product 

(Syngenta products account for 87% of paraquat market share in the United States; the products 

are a 30% AI concentration). Fourteen cases involved Gramoxone Inteon, six incidents involved 

Gramoxone 2.0 SL; and another 14 involved unspecified Gramoxone products. Two incidents 

involved multiple active ingredients but most included only paraquat dichloride or paraquat.

This analysis reveals that moderate paraquat exposure incidents are typical handler/product user 

related exposures involving splashes, spills or equipment malfunction during the handling of the 

product, including mixing, loading or applying the product or cleaning application equipment. 

Most cases appear to have taken place on a farm, which often was the residence of the 

farmer/applicator; however location and occupational information was often sparse in the case 

reports. Information regarding the level of training of users is not available in IDS reports. The 

reports were primarily the patient treatment dialogue between the healthcare provider and case 

intake reporter (Syngenta contracts with Prosar). Symptoms of the moderate severity paraquat 

incidents were typically dermal irritation including blisters, rashes, redness, followed by ocular 

exposures. Symptoms generally resolved within several days. However, there are a few reports 

of skin irritation persisting over a long period of time following a paraquat application exposure. 

The Syngenta incident reports frequently state the following regarding exposure to paraquat, 

“Intact skin is an effective barrier to Paraquat exposure and systemic toxicity is unlikely 

following brief dermal contact followed by appropriate decontamination. Concentrated solutions 

may result in irritation, blistering, or full thickness burns 1-3 days following exposure. Dilute 

solution may result in redness...”
10 | P a g e

There were also a number of inhalation exposure incidents (or combination dermal and 

inhalation) resulting from the same type of handler exposure scenarios as outlined above. Two 

separate incidents involved 15-year-old children, one was splashed in the eye by the product 

while applying with no PPE and the other child exposure report involved the accidental ingestion 

incident (mentioned above) where the child was orally exposed to the product when drinking 

from a Coke bottle, the child did not swallow the product and made a recovery. There are a total 

of 4 moderate severity cases in the above table that involved ingestion of small amounts of 

product; two of these cases involved drinking from mislabeled beverage containers. 

In sum, moderate severity incidents are generally typical exposures involving the occupational 

risks involved with handling a pesticide product (dermal, inhalation and ocular exposure due to 

leaks, spills, splashes or mist inhalation). However, the ingestion of even a very small amount of 

paraquat is highly toxic when ingested and may result in death or high severity health outcomes. 

See Appendix B for description of the moderate severity cases analyzed here.

b. SENSOR-Pesticides

The SENSOR-Pesticides database covers 11 states8from 1998-2010, although reporting varies 

from state to state. Cases of pesticide-related illnesses are ascertained from a variety of sources, 

including: reports from local Poison Control Centers, state Department of Labor workers’ 

compensation claims when reported by physicians, reports from State Departments of 

Agriculture, and physician reports to state Departments of Health. Although both occupational 

and non-occupational incidents are included in the database, SENSOR-Pesticides focuses on 

occupational pesticide incidents, and is of particular value in providing that information. The 

state coordinator at each of the 11 respective state Departments of Health conducts case followup activities such as obtaining medical records to verify symptoms and severity. Using 

standardized protocol and case definitions derived from poison center reporting, the state 

SENSOR-Pesticide coordinator enters the incident information into the state-based system which 

is sent to NIOSH annually to be aggregated. 

A query of SENSOR-Pesticides 1998-2010 identifies a total of 109 cases involving paraquat, 

stemming from 108 events. 87 of these cases involve a single active ingredient and 24 involved 

multiple active ingredients. There were two fatalities, two high severity cases, 25 moderate 

severity cases, and 80 low severity cases. 

The most frequent route of exposure are dermal, ocular, and inhalation. Two cases reported an 

unknown route of exposure. Table 4 shows the frequency for the routes of exposure of the 

paraquat cases.

 

8 California, Florida, Iowa, Louisiana, Michigan, North Carolina, New Mexico, New York, Oregon, Texas, 

Washington
11 | P a g e

Table 4. SENSOR-Pesticides 1998-2010: 

Route of Exposure for Paraquat Cases

Route of Exposure Frequency

Dermal 54

Ocular 41

Inhalation 37

Unknown 2

Injection 0

*Cases may report multiple routes of exposure

The most common reported health effects for paraquat cases are ocular, nervous system, and 

dermal symptoms. 66 of the 109 cases reported multiple types of health effects. Table 5 specifies 

all of the symptoms reported from SENSOR-Pesticide cases. 

Table 5. SENSOR-Pesticides 1998-2010: 

Reported Health Effects for Paraquat Cases

Health Effect # of Times Reported

Ocular 51

Nervous System 47

Dermal 42

Respiratory 33

Gastrointestinal 29

Cardiovascular 14

Miscellaneous 9

Renal 4

* Cases may report multiple health effects

11 SENSOR-Pesticides cases resulted from ingestion, including both of the fatalities. One 

fatality report was a suicide and the other involved a child who drank the paraquat out of a soda 

bottle (see NC01163). Two ingestion cases involved siphoning of paraquat by mouth. All 

available ingestion case descriptions are provided below in Table 6. 
12 | P a g e

Table 6. SENSOR-Pesticides 1998-2010

Paraquat Ingestion Cases

Case ID Severity Case Description

NC01163a Death An 8 year old child drank weed killer that had been put in a soda bottle 

and stored in garage.

Further detail regarding this death was obtained from the SENSORPesticides coordinator in North Carolina and stated the following, “8 

year old boy ingested paraquat from Dr pepper bottle on 7/29/08 and 

died at Duke medical center on 8/15/08. Family states older brother had 

used product on weeds around house and put it in a Dr. Pepper bottle in 

the garage and child found it on window sill. Older brother got it from

a family friend who is a certified applicator. Dept of Ag asked to 

investigate and counsel father on pesticide storage. Family has 8 other 

children, Social Services on case as well as police. Staff medical 

epidemiologist reviewed case. Materials sent to family on proper 

pesticide storage. NIOSH notified.

NC00164 Death On August 25, 2007 59 year old man presents to Sampson Regional 

Medical Center ED jaundiced with c/o dysphasia, shortness of breath. 

WS01693 Moderate Swallowed herbicide while siphoning it to another container.

NC01865 Moderate 46 year old man ingested 1 cup of gramoxone (paraquat) in a suicide 

attempt.

NC00881 Moderate Man was spraying paraquat around his home. Wind changed direction 

and blew in mouth. Later told NCDA he swallowed it.

WA02854 Moderate Patient was attempting to siphon paraquat and ingested it.

OR01222 Moderate no mask was used. Brought his own gloves & rubber suit, no rubber 

boots.

WA01557 Low A 52 y/o male farmworker applied herbicides to raspberries and 

blackberries for 3 days without symptoms. He then developed 

respiratory symptoms and his employer provide he and his coworkers 

with PPE. His coworker felt better but he continued feeling badly. His

symptoms improved after three weeks. However, he continued to have 

some respiratory symptoms and sought medical care.

FL01078 Low Patient started working for pesticide company 2 weeks ago and was 

spraying. He was spraying overhead so did get some on himself

CA07281 Low Spraying orange groves with roundup and without PPE. Exposed while 

spraying.

WA01991 Low Washing down tractor with a hose that had been used to fill a spray tank 

and splashed water back on herself.

SENSOR-Pesticides Severity Index: KEY

Death Human Fatality

High Life threatening, requires 

treatment

>5 days lost work/time

Moderate Involves systemic effects 3-5 days lost work/time

Minor Symptoms typically resolve 

without treatment <3 days lost work/time

a. A 2009 American Academy of Pediatrics publication describes this case report and states the family believed 

the herbicide stored in the soda bottle to be Amoxone (2,4-D). The patient was discharged after receiving 

supportive care in the hospital because he appeared well and 2,4-D is a “relatively benign herbicide that may 

produce short-term gastrointestinal symptoms”9

 

9 Chen, et al, Paraquat Ingestion: A Challenging Diagnosis. Pediatrics 2010; 125; e1505. Found online at: 

http://pediatrics.aappublications.org/content/125/6/e1505.full.pdf
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c. NPIC

NPIC prepared a special report of paraquat incidents from 1/1/07 – 5/31/13, there a total of four 

cases; no fatalities were reported, however, one case involved paraquat ingestion from a suicide 

attempt.

d. CDPR/PISP

CDPR is currently looking at all paraquat incidents reported to the Pesticide Illness Surveillance 

Program with the intent of putting out a Health and Safety Report. The report will be shared 

with EPA after it has been internally reviewed and cleared at CDPR. 

CDPR confirmed that from 1992-2010, there were a total of four paraquat ingestion cases 

reported (out of 101 total paraquat-related cases reported), three of which resulted in death. (An 

additional ingestion death corresponding with Dr. Gellar’s report was reported in 2013 but is not 

yet available in the public dataset.)

e. American Association of Poison Control Centers (AAPCC)

In their 10/7/13 letter to EPA, the AAPCC noted a total of 50 paraquat deaths reported to the 

National Poison Data System (NPDS) from 1983 to 2011. Of the 50 deaths: 33 were suicides, 15 

were due to unintentional exposures, and two were unknown. In the EPA response, we requested 

the case narratives for these fatalities. AAPCC has provided EPA with these narratives which 

are being reviewed. AAPCC also included this updated statement:

“Upon further examination, AAPCC has identified 51 US deaths attributed to paraquat published 

within the... annual reports between 1983 and 2011. Of these 51 deaths, we have been able to locate 

the fatality reports for 38. These are attached for review by the EPA. The missing abstracts are from 

the earlier years of the database’s existence.”

IV. Dataset Synopsis of Paraquat Dichloride Fatalities 

 Main IDS identifies 27 deaths from 1990-2013; three accidental ingestions deaths 

reported by CPCS are included in this total. 

 SENSOR-Pesticides 1998-2009 reports two deaths not found in IDS, including one 

accidental ingestion by a child and one suicide. 

 California PISP 2000-2010 identifies three deaths; at least two of which match with Dr. 

Gellar’s case reports.

 AAPCC reports 50 paraquat fatalities from 1983-2011.

V. CONCLUSION

The number of fatalities related to the ingestion of paraquat dichloride warrants closer 

examination and discussion with PRD and the paraquat dichloride registrants. 
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APPENDIX A.

Table A-1. Main IDS Paraquat Dichloride (pc code 061601) Deaths from 1990-Present (2/21/14)

Count Case ID Date State Severity Description

1 000741-00001 9/28/93 GA Death Man drank Gramoxone Extra to commit suicide: his stomach was 

lavaged & he was purged: he hemoperfused daily and died in hospital.

2 001045-00001 4/16/94 SC Death 45 yr old man drank 2 swallows of Gramoxone: vomited: apnea, lung 

fibrosis, kidney disfunction: man died of respiratory failure.

3 004599-00001 11/26/96 HI Death 75 yr. old Hawaiian man intentionally drank 30-60 ml of concentrated 

paraquat. He died 8 days later in hospital: renal failure, pulmonary 

edema.

4 007613-00001 8/5/98 LA Death Male’s 7th beer was tainted with paraquat. Caused nausea and diarrhea. 

Male taken to ICU, treated w/ atropine & 2 PAM, but died.

5 009542-00001 9/1/99 DE Death 16 yr. old developed vomiting & renal failure. Lung biopsy revealed 

pulmonary fibrosis. Paraquat level 7+ times normal level in urine.

6 010077-00001 4/10/00 GA Death 15 month old child ingested paraquat product in a Gatorade container. 

Acute renal failure, nitric oxide used, sepsis set in and the child died.

7 010504-00001 7/22/00 PR Death Man ingested Gramoxone Super Herbicide and Roundup in an 

apparent suicide.

8 010091-00001 3/1/00 CA Death Updates HB #010054-00002. 14 year old females presented with 

pulmonary fibrosis; later died.

9 010440-00001 7/7/00 PR Death Apparent suicide from ingestion of paraquat dichloride, Puerto Rico.

10 010666-00001 9/14/00 MS Death Man at Farmers Supply coop drank 1 cup of Gramoxone Extra in an 

apparent suicide. Died in Jackson University Hospital.

11 010677-00001 5/1/00 IL Death Farmer applied product within 100 ft. of 7 people. Wind blew mist, 

people washed, but death of 2 people, Dyspnea in several people.

12 010677-00001 5/1/00 IL Death Farmer applied product within 100 ft. of 7 people. Wind blew mist, 

people washed, but death of 2 people, Dyspnea in several people.

13 010591-00001 8/20/00 NM Death Suicide ingestion.

14 011958-00001 8/11/01 PA Death 38 yr. old female argued with friend, intentionally drank alcohol, then 

drank Gramoxone, and jumped into pond. Died, multiple organs 

failed.

15 013569-00001 11/10/02 OH Death man ingested gulp of paraquat from Pepsi bottle. Was put on 

ventilator, given renal dialysis. Died.

16 013372-00001 10/1/02 GA Death The circumstances of exposure are unclear. On 10/2/02, caller 

indicated soman drank sips of paraquat by accident as she reached for 

her coffee. On 10/4/02, the history was altered, “During the night the 
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patient got up to get some cough medicine which was sitting next to 

the product and took product by mistake”.

17025332-004

(Update to 

014885-00026)

3/5/03 CA Death An adult male was making an application of paraquat to his yard. He 

had two coffee cups in his garage, one contained coffee and the other 

contained paraquat. He accidentally took a sip of the paraquat and 

immediately spit it out. About an hour later he started to feel sick and 

drove himself to the hospital. His condition progressively got worse 

and he died on March 12, 2003. The cause of death established by the 

coroner was acute paraquat intoxication and multiple organ failure.

18 015546-00001 9/9/04 TX Death Human death with possible paraquat exposure. Patient was seen in ER 

and treated. Patient later died from significant lung fibrosis. 

19 016020-00001 2/24/05 CA Death It appears that the individual intentionally consumed a pesticide 

product from an unlabelled container with the intention of harming 

himself. The patient developed symptoms that are consistent with 

paraquat ingestion and was treated at the hospital. The patient 

eventually expired. Analysis of the patient’s urine confirmed the 

presence of paraquat; however, the exact formulation of herbicide that 

was ingested is unknown.

20 016630-00001 9/10/05 FL DeathMan drank paraquat & organophosphates out of bottle. Intubated at 

hospital, significant respiratory symptoms, blue sweat & urine. 

Accidental ingestion.

21 016310-00001 6/3/05 NC Death 48 yr. old man was apparently transferring straight product from a 

glass jar to a sprayer. He reportedly drank from that container by 

accident He thought he’d consumed tobacco spittle, so he didn’t seek 

medical attention immediately for the vomiting noted shortly 

afterward, according to the brother. Tested for drugs, apparently. Had 

been going through alcohol withdrawal according to brother. Never 

any mention of a suicide attempt. 

22 018909-00001 8/24/07 NC Death A 59 year old male died of cardiac arrest and multi system organ 

failure in the hospital. It was not clear if he drank the product 

intentionally or not.

23025332-00002

(Update to 021704-

00006)

1/13/10 CA Death A 44 year old male mistakenly drank the product and developed 

difficulty in breathing and vomiting of blood. He was admitted to the 

intensive care unit.

24 023121-00001 7/12/11 SC Death Suicide, multiple products.

25 025332-00001

(025400-00001

updates this)

6/1/13 CA Death 70 yr. old female ingested some contents of a re-used iced tea bottle, 

which unknown to her contained Gramoxone. She presented awake 

and alert with persistent vomiting. Over the course of a 16 day 

admission she evolved the classic picture of paraquat ingestion: 
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corrosive gastrointestinal injury plus renal and pulmonary failure 

leading to death. 

26 025635-00001 8/19/13 NJ Death Gramoxone & iced tea ingestion in suicide case: 25 yr. old male at 

work as a landscaper. Discussed desire to commit suicide with 

coworker. Drank out of 2-2.5 gallon canister. Vomited, became 

lethargic, taken to hospital for gastric lavage. Intubated, tachycardic, 

hypothermia, later died.

27 026120-00001 1/25/14 CA Death A man drank paraquat while trying to kill himself. Drank an estimated 

8-10 ounces from a cranberry juice bottle. Nausea, vomiting, diarrhea, 

bloody vomiting, died two days later.

.
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APPENDIX B.

Moderate Severity (HC) Paraquat Incident Reports: Main IDS 2010-2013

Identification

Incident 

Date State Product Reg # Symptoms Description

1 021573-00005 6/23/08 NE Gramoxone Inteon 100-1217 Dermal irritation Got product on hand 18 months priorrecurring/worsening dermal irritation

2 021807-00005 3/19/10 AL Gramoxone Inteon + 

Sevin

100-1217 High BP, bad taste 

in mouth

Inhaled mist in enclosed cab

3 021985-00143 5/26/10 IN Gramoxone Inteon 100-1217 Rash, blisters Splash on leg

4 022107-00007 6/15/10 NC Gramoxone Cornea burn, nose 

bleed, GI

Splashed on face

5 022107-00012 6/23/10 KY Gramoxone Inteon 100-1217 Oral burns, tongue 

blisters

15-yr-old had some in mouth- drank from a 

Coke bottle- full strength- did not swallow

6 022107-00067 6/25/10 AR Gramoxone Inteon 100-1217 Dermal redness May have gotten product on leg- used 3 

weeks prior

7 022281-00028 8/16/10 AR Gramoxone Chest pain Wife inhaled spray

8 022281-00029 8/19/10 TX Gramoxone Inteon Skin irritation Splashed on chest

9 022466-00005 9/30/10 FL Gramoxone Inteon 100-1217 Dermal abrasion on 

face, bleeding

Splashed on face while opening

10 023072-00181 5/28/11 TN Gramoxone Farmer sprayed product in his eye

11 023072-00182 6/21/11 AR Gramoxone Rash, neurological Case inhaled product mist – occurred on a 

farm

12 023253-00008 7/30/11 CA Gramoxone Inteon Ingestion from unmarked milk carton-

“intentional”- CDPR report

13 023187-00023 7/1/11 CA Gramoxone HB

14 023289-00009 8/20/11 SC Gramoxone Inteon Skin blisters Got some product on gloves

15 023289-00007 8/23/11 MS Gramoxone Blisters Sprayed on legs

16 023289-00008 6/2010 GA Gramoxone Inteon 100-1217 Recurring dermal/ 

cardiovascular

Truck driver spilled product onto his body 

while transferring the product

17 023388-00005 9/27/11 HI Gramoxone Throat swelling Drank ~1 tsp. of product

18 023490-00008 10/3/11 TX Gramoxone Respiratory Mixing/loading splash

19 024040-00097 4/19/12 PA Gramoxone 2.0 SL 100-1431 Rash Inhalation/dermal exposure

20 024040-00095 4/6/12 TN Gramoxone 2.0 SL 100-1431 Blisters Splash- equipment malfunction

21 024040-00098 4/12/12 NC Gramoxone Stroke HB

22 024186-00205 5/8/12 MO Gramoxone Inteon 100-1217 Blisters, dermal 

pain

Occupational exposure to concentrate- got a 

drop on nose
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23 024186-00204 5/7/12 MD Gramoxone Numbness Applied weeks prior to symptoms; did not 

ingest, may have gotten some on skin or 

inhaled fumes

24 024275-00075 6/22/12 NC Gramoxone 2.0 SL 100-1431 Cough Inhalation- mixed and applied product to a 

pasture, started coughing (has COPD)

25 024275-00068 5/30/12 VA Gramoxone Inteon + 

glyphosate

GI Application inhalation

26 024379-00031 7/28/12 AR Gramoxone Ocular pain Splashed product in eye

27 024497-00010 5/11/12 GA Product not specified Gastrointestinal, 

shortness of breath

Inhalation; occurred on farm

28 024497-00009 ~8/23/12 TX Gramoxone 2.0 SL 100-1431 Headache, abnormal 

blood cell count,

fever

Applying in enclosed cab- stepped out and 

inhaled mist

29 024539-00007 9/6/12 CA Gramoxone Inhalation while spraying field- no PPE

30 024807-00006 ~11/4/12 MS Gramoxone Severe dermal, skin 

peeling

Spilled product, soaked through gloves

31 024870-00010 12/6/12 AL Gramoxone Inteon 100-1217 Neurological, 

cardiovascular, 

respiratory

Inhalation and dermal exposure while 

applying product

32 025215-00016 4/6/13 TX Gramoxone Inteon 100-1217 Blisters, burns on 

mouth

Oral exposure from contaminated hose

33 025215-00021 4/29/13 CA Gramoxone 2.0 SL 100-1431 Ocular, dermal Sprayed in the face from a leak in the hose 

of a spray tank, was wearing glasses

34 025458-00007 6/12/13 AL Gramoxone 2.0 SL 100-1431 Ocular pain 15 year old was spraying crops, ocular 

exposure

35 025458-00011 ~6/24/13 GA Gramoxone Dermal Exposed when rinsing equipment