Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-8699

2. Registrant Information.

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

Address: 77 Belfield Rd

City: Toronto

Prov / State: ON

Country: Canada

Postal Code: M9W 1G6

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

Human

4. Date registrant was first informed of the incident.

27-JUN-07

5. Location of incident.

Country: UNITED STATES

Prov / State: ARKANSAS

6. Date incident was first observed.

Unknown

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: Tempo

• Active Ingredient(s)
  • CYFLUTHRIN
    • Guarantee/concentration 1 %

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7. b) Type of formulation.

Dust

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Agricultural-Indoor / Agricole-intérieur

Préciser le type: poultry house

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

Caller stated that he used this product in his poultry house every nine week for the last 2 years. The last use was 8 weeks ago, some of the product got onto his skin. He diluted after use.

To be determined by Registrant

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

No

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

• Blood
  • Symptom - Other
  • Specify - too many Red Blood Cells

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

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)

Unknown

10. Route(s) of exposure.

Skin

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.)

Caller stated that he used this product in his poultry house every nine week for the last 2 years. The last use was 8 weeks ago, some of the product got onto his skin. He diluted after use. He reports that he is producing too many RBC. This elevation started 6 months ago. He has had 4 tests in the last 6 months and the RBC have been elevated on all 4 tests. He has been evaluated by an MD. MD is working with caller to determine cause of the elevation

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

[Name] Jul 4, 2007 9:42AM [Name] is still working with the doctor in finding out the cause of his over production of RBC, he goes back later this month. Told him to cb or have doctor cb if any questions for us.