Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2499

2. Registrant Information.

Registrant Reference Number: Prosar case 1-15766311

Registrant Name (Full Legal Name no abbreviations): FMC Corporation

Address: 1735 Market Street

City: Philadelphia

Prov / State: Pennsylvania

Country: USA

Postal Code: 19103

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

Human

4. Date registrant was first informed of the incident.

07-FEB-08

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

07-FEB-08

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. 24175      PMRA Submission No.       EPA Registration No.

Product Name: Dragnet FT Emulsifiable Concentrate Insecticide

• Active Ingredient(s)
  • PERMETHRIN

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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: Unknown / Inconnu

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

Product was diluted at the time of use.

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

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Foreign body sensation in eye
  • Symptom - Irritated eye

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.

Eye

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 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.)

1-15766311: The reporter called on 2/7/08 to report that he had been exposed to a product which contains the active ingredient Permethrin. The reporter was at work during the time of exposure (2/7), spraying the product which had been diluted prior to use. According to the reporter, there was a pinpoint hole in the plastic line and as a result some of the product was sprayed into his eye. The reporter stated he rinsed his eye for several minutes and then went home and showered to rinse the eye some more. At the time of the call, 2 hours had elapsed from the exposure and the reporter still felt as if he had some of the product in his eye. First-aid recommendations were made and included additional rinsing of the eye, refraining from the use of over the counter eye drops, and seeing a physician if the symptoms lasted for more than 6 hours. On follow-up a message was left for the reporter, but no response was ever received.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.