Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-1057

2. Registrant Information.

Registrant Reference Number: 202982

Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.

Address: Suite 100, 3131 114 Avenue SE

City: Calgary

Prov / State: AB

Country: Canada

Postal Code: T2Z 3X2

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

24-JUN-07

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

23-JUN-07

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. 12287      PMRA Submission No.       EPA Registration No.

Product Name: MONITOR 480 INSECTICIDE (Canada)

  • Active Ingredient(s)
    • METHAMIDOPHOS

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.

Data Subject

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 - Nausea
  • Nervous and Muscular Systems
    • Symptom - Headache

4. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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)

Other

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.

Respiratory

11. What was the length of exposure?

<=15 min / <=15 min

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.)

6/24/2007 Caller found a container of product while cleaning a building on his property one day ago. Caller opened the container and smelled the odor of product, and developed a headache and nausea. Symptoms are improving with fresh air. 6/25/2007 Original caller called back stating that he is still feeling symptoms. Evaluation by MD was recommended to caller. 6/26/2007 Call back placed to caller for follow up. Caller has not seen MD for evaluation yet, and symptoms have subsided with no further treatment. 7/2/2007 Call back made to caller for follow up information. Message was left for caller. 7/3/2007 Original caller is calling back returning previous message. He decided he wanted to be checked out by a doctor just to make sure all was well. Caller was evaluated by MD, and a general physical examination and blood test was performed. Test results were within normal limits, and caller has had no further symptoms. No treatments needed.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.