Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-4206

2. Registrant Information.

Registrant Reference Number: 2009-21

Registrant Name (Full Legal Name no abbreviations): BASF Canada

Address: 100 Milverton, 5th floor

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5R4H1

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

Human

4. Date registrant was first informed of the incident.

19-AUG-09

5. Location of incident.

Country: CANADA

Prov / State: UNKNOWN

6. Date incident was first observed.

16-AUG-09

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. 15738      PMRA Submission No.       EPA Registration No.

Product Name: RIPCORD 400

• Active Ingredient(s)
  • CYPERMETHRIN

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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).

Caller reports using Ripcord 8.16 and she was wearing gloves at time of spraying.The nozzle of the product had been blocked and she had to clean that nozzle with her gloved hand. At some point a mosquito landed on her forehead and she swatted at the mosquito with her gloved hand. She immediately had aburning sensation at that area and went inside and washed it off immediately.

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: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Erythema
  • Symptom - Rash

• General
  • Symptom - Edema

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

Unknown

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)

Chemical resistant gloves

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

<=15 min / <=15 min

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.)

Caller reported 2 very visable reddened and puffy eyes on her forehead where she swiped the glove.Her left eye is also very puffy but is on the opposite side of the forehead exposure.Symptoms are consistent with a contact dermatitis associated with exposure to a pyrethrin-based insecticide. Recommended use of hydrocortisone cream to reddened area for next couple of days, if rash does not get better or worsens, refer to PMD.Unable to say why left eye is puffy, does not seem to be related to exposure. follow-up,rash cleared up in one day;caller tells pcc that she applied a steroid cream to the area she had from poison ivy earlier in the year.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.