Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-1759

2. Registrant Information.

Registrant Reference Number: 1924040

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.

09-APR-08

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW JERSEY

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: SpaGuard Brominating Tablets for Spas and Hot Tubs25542

• 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: 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).

Spa bromine levels were too high

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Irritated skin
  • Symptom - Pain

• Nervous and Muscular Systems
  • Symptom - Numbness

• Renal System
  • Symptom - Kidney pain
  • Symptom - Painful urination
  • Specify - urethra burning and bladder pain
  • Symptom - Other
  • Specify - tenderness in groin area

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

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)

Contact with treated area

What was the activity? sitting in treated spa

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

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.)

Person alleges that his doctor believes that someone is trying to poison him.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.