Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-5596

2. Registrant Information.

Registrant Reference Number: 2017-20

Registrant Name (Full Legal Name no abbreviations): BASF Canada

Address: 100 Milverton

City: Mississauag

Prov / State: ON

Country: Canada

Postal Code: L5R4H1

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

Human

4. Date registrant was first informed of the incident.

21-SEP-17

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

20-JUL-17

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)

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PMRA Registration No. 30337      PMRA Submission No.       EPA Registration No.

Product Name: Twinline

• Active Ingredient(s)
  • METCONAZOLE
  • PYRACLOSTROBIN

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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: wheat

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

On July 12, tractor broke down while applying Twinline fungicide to cereal. Applicator (no protective clothing) walked out of field. Additional man (mechanic) worked on repair of tractor for 1 day. On July 18th, potential 2nd exposure as applicator walked through field.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Yes

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

• General
  • Symptom - Flu-like symptoms

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.

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Contact with treated area

Amount of time between application and contact .1

Hour(s) / Heure(s)

What was the activity? walking through sprayed crop

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>1 wk <=1 mo / > 1 sem < = 1 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.)

Flu-like symptoms first observed on July 20 in applicator, 8 days after first exposure. Mechanic reported no symptoms. On day 3 of symptoms (July 23), applicator went to hospital and was checked out for west nile, malaria, nutrients (all negative) and sent home with pain medication. Made full recovery.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.