Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3687

2. Registrant Information.

Registrant Reference Number: PROSAR Case# 1-23373104

Registrant Name (Full Legal Name no abbreviations): FMC Corporation

Address: 1735 Market Street

City: Philadelphia

Prov / State: PA

Country: USA

Postal Code: 19103

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

Human

4. Date registrant was first informed of the incident.

07-JUL-10

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

07-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. 24360      PMRA Submission No.       EPA Registration No.

Product Name: Dragnet FT Emulsifiable Concentrate

• Active Ingredient(s)
  • PERMETHRIN

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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.

Data Subject

2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Irritated nose

• General
  • Symptom - Chemical taste in mouth

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?

Unknown

6. b) For how long?

7. Exposure scenario

Unknown

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

Pesticide Spill

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.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

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.)

1-23373104- The reporter calls to indicate exposure to an insecticide containing the active ingredient permethrin. The caller reports a friend had spilled product in his car earlier in the day. The caller describes helping this friend clean up the product (unknown concentration/unknown amount) after the spill in the vehicle. Personal protective equipment was not described. The caller did not indicate the duration, route, or a discreet exposure event. He indicates in the four hours since he helped clean up the product his upper airway (nasal passages) have had a burning sensation and he has had a "funny taste" in his mouth. The caller was advised fumes associated with the product could be considered primarily respiratory irritants. The caller was advised to seek fresh air and to seek medical care for symptomatic relief if symptoms worsened or persisted. The caller was unable to be reached for routine follow up. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.