Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-1075
2. Registrant Information.
Registrant Reference Number: 197955
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.
Human
4. Date registrant was first informed of the incident.
12-JUN-07
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
10-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)
PMRA Registration No. 21374
PMRA Submission No.
EPA Registration No.
Product Name: Gluthion Solupak
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: Application to farm field 33 ft from place of residence.
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.
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: Female
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
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?
No
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)
None
10. Route(s) of exposure.
Unknown
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
>8 hrs <=24 hrs / > 8 h < = 24 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.)
6/12/2007 Caller states that a neighboring farmer was spraying diluted product 33ft from where they live. Application was done in the morning of June 10. Family is leasing a farm house. There was no known or observed exposure but they speculate that some type of spray drift occurred. Caller reports becoming sick to her stomach an unspecified period of time after application. She also states developing a headache ,although she had a history of recurring headaches prior to this incident. Daughter later complained of stomach ache, diarrhea, and head ache the evening of June 11. Husband also reports experiencing nausea, upset stomach and same overall sxs as daughter but his onset of symptoms more unknown. Follow-up messages were left with family on 6/14 and 6/15 requesting they follow-up regarding this incident, but no return calls were made by the family. Case closed on 6/19/2007 after receiving no follow-up from the family.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
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
- Gastrointestinal System
- Symptom - Diarrhea
- Symptom - Nausea
- Nervous and Muscular Systems
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?
No
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)
None
10. Route(s) of exposure.
Unknown
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
>8 hrs <=24 hrs / > 8 h < = 24 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.)
6/12/2007 Caller states that a neighboring farmer was spraying diluted product 33ft from where they live. Application was done in the morning of June 10. Family is leasing a farm house. There was no known or observed exposure but they speculate that some type of spray drift occurred. Caller reports becoming sick to her stomach an unspecified period of time after application. She also states developing a headache ,although she had a history of recurring headaches prior to this incident. Daughter later complained of stomach ache, diarrhea, and head ache the evening of June 11. Husband also reports experiencing nausea, upset stomach and same overall sxs as daughter but his onset of symptoms more unknown. Follow-up messages were left with family on 6/14 and 6/15 requesting they follow-up regarding this incident, but no return calls were made by the family. Case closed on 6/19/2007 after receiving no follow-up from the family.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
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: Female
Age: >1 <=6 yrs / > 1 < = 6 ans
3. List all symptoms, using the selections below.
System
- Gastrointestinal System
- Symptom - Diarrhea
- Symptom - Nausea
- Nervous and Muscular Systems
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?
No
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)
None
10. Route(s) of exposure.
Unknown
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
>24 hrs <=3 days / >24 h <=3 jours
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.)
6/12/2007 Caller states that a neighboring farmer was spraying diluted product 33ft from where they live. Application was done in the morning of June 10. Family is leasing a farm house. There was no known or observed exposure but they speculate that some type of spray drift occurred. Caller reports becoming sick to her stomach an unspecified period of time after application. She also states developing a headache ,although she had a history of recurring headaches prior to this incident. Daughter later complained of stomach ache, diarrhea, and head ache the evening of June 11. Husband also reports experiencing nausea, upset stomach and same overall sxs as daughter but his onset of symptoms more unknown. Follow-up messages were left with family on 6/14 and 6/15 requesting they follow-up regarding this incident, but no return calls were made by the family. Case closed on 6/19/2007 after receiving no follow-up from the family.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.