Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3640

2. Registrant Information.

Registrant Reference Number: 2010-35

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.

16-JUL-10

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

05-JUL-10

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. 29767      PMRA Submission No.       EPA Registration No.

Product Name: CARAMBA

• Active Ingredient(s)
  • METCONAZOLE

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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.

Data Subject

2. Demographic information of data subject

Sex: Female

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

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Itchy eye

• Nervous and Muscular Systems
  • Symptom - Numbness

• General
  • Symptom - Drowsiness

4. How long did the symptoms last?

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

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-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.

Skin

Eye

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.)

An aerial spray plane sprayed her yard July 5th. She said she was outdoors and the product got onto her. She immediately developed itchy eyes and within a couple of hours felt tired and her right hand went numb. She took a shower immediately after. She went to her physician who flushed her eyes out and gave her (unknown) eye drops. She is still feeling tired and having the numbness (July 16th).

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Not expected reaction from the product;if in eyes, can expect eye irritation. Product is not expected to cause reported symptoms or this persistence of symptoms-recommend she continue to follow-up with her physician regarding her symptoms.