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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4530

2. Registrant Information.

Registrant Reference Number: 184272

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.


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: FLORIDA

6. Date incident was first observed.


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.


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

Product Name: Suspend SC

  • Active Ingredient(s)
      • Guarantee/concentration 4.75 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Res. - In Home / Rés. - à l'int. maison

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

See main notes on subform II

To be determined by Registrant

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


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.


  • Gastrointestinal System
    • Symptom - Stomach pain
    • Symptom - Anorexia
    • Symptom - Constipation
  • Nervous and Muscular Systems
    • Symptom - Headache
    • Symptom - Muscle weakness
    • Symptom - Muscle spasm

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?


Day(s) / Jour(s)

7. Exposure scenario


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

Contact with treated area

What was the activity? Reentry in home after floor covering in home allegedly sprayed with product

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


10. Route(s) of exposure.


11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

5/7/2007 Caller states that near the end of Feb. and then in the beginning of March he had his house sprayed by a PCO two times with the product. The carpets and different rugs in the house were saturated with the product. He came back into the house and since that time has developed symptoms including Gastritis, headache, abdominal pains, muscle spasms, constipation, anorexia and weight loss of 20 lbs. He is very weak already from his disability and this is making him worse. He has been in and out of the hospital 8 times (apparently 8 different hospitals). He states he can still smell material in his home, although no one else who has come into the home can smell anything. He has been hospitalized for almost 2 months straight now and the last time he was home was for 2 hours - this exposure put him back in the hospital. He did have his house professionally cleaned one time, but this did not help. Patient was advised that his myriad of symptoms are not expected from the routine use of this pesticide in his home and that if he believes there is a link between the pesticide and illness, he should seek an comprehensive evaluation by an ABMT Board Certified Medical Toxicologist who would be most qualified to assess an illness he believes is related to an exposure to a pesticide.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.