Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4586

2. Registrant Information.

Registrant Reference Number: 2007-16

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

Address: 100 Milverton Dr., 5th Floor

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5R 4H1

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

Human

4. Date registrant was first informed of the incident.

09-JUL-07

5. Location of incident.

Country: UNITED STATES

Prov / State: INDIANA

6. Date incident was first observed.

29-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)

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

Product Name: Headline

• Active Ingredient(s)
  • PYRACLOSTROBIN
    • Unknown

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7. b) Type of formulation.

Liquid

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: Field next to caller

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

Home & property adjacent to field being aerially sprayed with Headline EC.Windows of home were open and AC was on. Spray was evident on his vehicles and drifted into his home.

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: >12 <=19 yrs / >12 <=19 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Burning skin
  • Symptom - Cyanosis

• Nervous and Muscular Systems
  • Symptom - Headache

• Respiratory System
  • Symptom - Dyspnea

• General
  • Symptom - Drowsiness

• Eye
  • Symptom - Burning eye

• General
  • Symptom - Lethargy

• Respiratory System
  • Symptom - Coughing

4. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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

No

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)

Drift from the application site

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

10. Route(s) of exposure.

Unknown

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.)

Man initially c/o skin and eyes burning, trouble breathing and a headache. He showered, rinsed his eyes and then talked to a poison control centre.He took 3-4 showers but experience significant burning of his skin and trouble breathing for 2 days. He has had a cough for several days now producing phlegm, feels sluggish.No h/o asthma but has history of pneumonia 4x in past.,has used an inhaler in the past.Denies smoking, has had pulmonary function tests done in past. Caller obtained MSDS on product. Appropriate first aid at time of exposure, dermal and respiratory irritation with cough.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

Major because cyanosis reported as symptom. Irritation/pain-unknown if related Drowsiness/lethargy-unrelated Headache-unrelated Cyanosis-unrelated Dyspnea-unrelated