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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4324

2. Registrant Information.

Registrant Reference Number: 2007001

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

Address: Suite 100, 3131 114th Avenue SE

City: Calgary

Prov / State: Alberta

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.

29-APR-07

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW YORK

6. Date incident was first observed.

29-APR-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.       PMRA Submission No.       EPA Registration No.

Product Name: Drione Insecticide

  • Active Ingredient(s)
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration 10 %
    • PYRETHRINS
      • Guarantee/concentration 1 %
    • SILICA AEROGEL
      • Guarantee/concentration 40 %

7. b) Type of formulation.

Dust

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.

Medical Professional

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

  • Cardiovascular System
    • Symptom - Other
    • Specify - Myocardial infarction

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Yes

6. a) Was the person hospitalized?

Unknown

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)

None

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 h

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.)

Paramedic called to report that he was called to the scene of a patient who had collapsed while he was applying an insecticide and a nitrogen based fertilizer to his lawn. It is not known how the patient would have been exposed to the materials he was applying to his lawn. The patient was found to be in cardiac arrest, and suspected to be experiencing a myocardial infarction. Following his resuscitation, the patient was transferred to and admitted to a local hospital where it was verified the patient suffered a myocardial infarction. The treating hospital physicians had determined the patient's illness was unrelated to the lawn chemicals he was using the day he collapsed in his yard.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.