Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-1007

2. Registrant Information.

Registrant Reference Number: 496457

Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.

Address: #200, 160 Quarry Park Blvd SE

City: Calgary

Prov / State: AB

Country: Canada

Postal Code: T2C 3G3

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

Human

4. Date registrant was first informed of the incident.

03-JUL-09

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

29-JUN-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. 22659      PMRA Submission No.       EPA Registration No.

Product Name: THUMPER HERBICIDE (Canada)

• Active Ingredient(s)
  • 2,4-D (PRESENT AS LOW VOLATILE ESTERS)
  • BROMOXYNIL

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7. b) Type of formulation.

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: Male

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Diarrhea
  • Symptom - Vomiting

• Skin
  • Symptom - Red skin

• General
  • Symptom - Flu-like symptoms

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?

No

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)

None

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.

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.)

7/3/2009 Caller states that on 6/30/09, her (age) son was splashed in the face with product, which had been mixed with two other herbicide products that she did not have the names of. He then attempted to rinse his face, not realizing that he was using the same herbicide mixture diluted in water to do so rather than plain water. Skin became red. No product was swallowed, but it may have gotten into his eyes. Caller then saw what he was doing and had him wash off with water and shampoo. The following day, son developed diarrhea, and today has had vomiting. Caller also suspects that he may just have the flu, since a number of other family members who were not exposed to the herbicides have been suffering from similar illness over the past week. 7/7/2009 Attempted callback to original caller. A message was left requesting follow up information. 7/8/2009 Attempted callback to original caller. A message was left requesting follow up information.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.