Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-1757

2. Registrant Information.

Registrant Reference Number: 1873075

Registrant Name (Full Legal Name no abbreviations): BioLab Inc., A Chemtura Company

Address: 1005 Copperstone Drive

City: Pickering

Prov / State: ON

Country: Canada

Postal Code: L1W 4A5

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

Human

4. Date registrant was first informed of the incident.

21-JAN-08

5. Location of incident.

Country: UNITED STATES

Prov / State: NEBRASKA

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. 5185-420

Product Name: BioGuard Brominating Tablets20102

• Active Ingredient(s)
  • 1-BROMO-3-CHLORO-5,5-DIMETHYLHYDANTOIN
    • Guarantee/concentration 98 %

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7. b) Type of formulation.

Tablet

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Pub. Area - Indoor/Zone publique - int

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

Product was applied to pool through the skimmer as instructed on label, however, a pH balancer was also being used at the same time that is not a registered product and that interacted with some weights on the bottom of the therapy pool. BioLab does not believe that this event could have transpired in the manner she described.

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: Female

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

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Sinus pain
  • Specify - sinus irritation and pain

• Eye
  • Symptom - Dry eye
  • Specify - unable to produce tears

• General
  • Symptom - Other
  • Specify - damaged vocal cords

4. How long did the symptoms last?

Anticip. permanent/Permanence anticipée

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

Yes

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)

Contact with treated area

What was the activity? swimming in treated water

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.

Skin

Oral

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

Person alleges that she inhaled the treated water around the weights that were at the bottom of the therapy pool where she was going for physical therapy and thereby inhaled the concentration of both chemicals that have caused her symptoms. In the US, this would be a major event, but I couldn't find some of the symptoms in the lists, and in the end decided to file this event, albeit late, just to be sure.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.