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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4956

2. Registrant Information.

Registrant Reference Number: 696795

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.


4. Date registrant was first informed of the incident.


5. Location of incident.



6. Date incident was first observed.


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. 432-1373

Product Name: Tempo 1% Dust

  • Active Ingredient(s)
      • Guarantee/concentration 1 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 432-1483

Product Name: Temprid SC Insecticide

  • Active Ingredient(s)
      • Guarantee/concentration 10.5 %
      • Guarantee/concentration 21 %

7. b) Type of formulation.


Other (specify)


Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Res. - In Home / Rés. - à l'int. maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.


2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.


  • General
    • Symptom - Death
  • Cardiovascular System
    • Symptom - Other
    • Specify - Aortic Aneurysm

4. How long did the symptoms last?

Persisted until death

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


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


9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


11. What was the length of exposure?

>1 mo <= 6 mos / > 1 mois < = 6 mois

12. Time between exposure and onset of symptoms.

>2 mos <=6 mos / > 2 mois < = 6 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.)

9/24/2010 Call received from a pest control operator. The caller explained that a now deceased coworker had worked as a PCO for this company for a 4 to 5 year period ending sometime in 2008. After the caller had heard that the former employee had died sometime in late August 2010 due to a aortic aneurism he became concerned that he may be at risk for health problems since he is using the same insecticide. He denies personally experiencing any adversity, nor was he able to describe any known instance of exposure in either himself or the coworker from 2 year sago. He has spoken with his personal MD who explained that the connection between the coworker dying from a aortic anuerism and his use of Tempo are completely unrelated. The caller has no knowledge or information regarding the medical care of the now deceased coworker. Unknown if he was hospitalized or treated by a physician. The caller was informed that the cardiovascular event reported in this case are not consistent with the known toxicology profile of Temp when it has been used in the manner described. The weight of medical and scientific data on cyfluthrin containing insecticides found in the peer-reviewed scientific literature or from post-marketing data does not support the notion that profound toxicity such as an aortic anuerism following routine insecticide use is biologically plausible.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.