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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2449

2. Registrant Information.

Registrant Reference Number: 182492

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.

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

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.

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 432-1385

Product Name: Premise Granules (EPA# 432-1385)4321385

• Active Ingredient(s)
  • IMIDACLOPRID
    • Unknown

7. b) Type of formulation.

Granular

Application Information

8. Product was applied?

Unknown

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: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Irritated eye

• Respiratory System
  • Symptom - Irritated throat

• Nervous and Muscular Systems
  • Symptom - Headache

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

Occupational

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

Other

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.

Eye

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>1 wk <=1 mo / > 1 sem < = 1 mois

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.)

(name): Eye + throat irritation, headaches-approx. (weight). - went to (name) Clinic, has been going for other health issues besides alleged issues with Premise. Symptom onset in less than 1 day (name) : Eye irritation, approx. (weight) - went to (name) Clinic, has been going for other health issues besides alleged issues with Premise. Symptom onset in less than 1 day (name): Eye + Throat irritation- approx. (weight).; symptom onset within a few weeks. PPE was made available: (name) - NIOSH Respirator, latex gloves + goggles (name) - NIOSH Respirator

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.