Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-0792

2. Registrant Information.

Registrant Reference Number: 323389

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.

24-MAY-08

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

24-MAY-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)

PMRA Registration No. 27453      PMRA Submission No.       EPA Registration No.

Product Name: PONCHO 600 FS (Canada)

  • Active Ingredient(s)
    • CLOTHIANIDIN

PMRA Registration No. 27564      PMRA Submission No.       EPA Registration No.

Product Name: PROSPER FL (Canada)

  • Active Ingredient(s)
    • CARBATHIIN
    • CLOTHIANIDIN
    • METALAXYL
    • THIRAM

7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

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

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

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.

Other

2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.

System

  • Skin
    • Symptom - Irritated skin
    • Symptom - Itchy skin
    • Symptom - Rash

4. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Contact with treated area

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.

Unknown

11. What was the length of exposure?

<=15 min / <=15 min

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.)

5/24/2008 Caller states that an employee had been opening bags of seed treated with product, and was pouring the seeds into hoppers around four hours ago. The employee had no known direct exposure to product. After returning home from work several hours later the employee developed redness, irritation, and itching on areas of both arms. 6/3/2008 Follow-up with original reporter. He provided the registration numbers of 27453 and 27564 but these were not from the bags the patient actually handled, so the actual seed products used remains speculative. Caller notes that apparently that patient symptoms did not start until after he arrived home. Apparently he had no notable exposure to the product other than just opening up seed bags and pouring them in the hoppers. The employee stated that symptoms improved after showering, and had resolved by the next day with no additional treatment.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.