Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5111

2. Registrant Information.

Registrant Reference Number: 694788

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.

20-SEP-10

5. Location of incident.

Country: UNITED STATES

Prov / State: LOUISIANA

6. Date incident was first observed.

Unknown

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.       PMRA Submission No.       EPA Registration No. 432-1391

Product Name: Premise Foam

• Active Ingredient(s)
  • IMIDACLOPRID
    • Guarantee/concentration .05 %

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7. b) Type of formulation.

Other (specify)

Foam

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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?

Yes

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

• General
  • Symptom - Drowsiness

• Nervous and Muscular Systems
  • Symptom - Ataxia
  • Symptom - Muscle tremors

• Renal System
  • Symptom - Renal failure

4. How long did the symptoms last?

Unknown / Inconnu

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)

Other

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.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

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.)

9/20/2010 Caller states that he has been living in an apartment for the past 2 years, spending 14 days there and then 14 days away alternately. At some point (unknown when), someone, possibly a pest control worker, was hired by the building owners of the building to apply the pesticide to the apartment's window-sills. Caller has found that there is an odor of this in the apartment. Starting about 7/4/10, he developed episodes of trembling and uncharacteristic sleepiness. On about 7/20 and 8/17, he experienced episodes of loss of balance. Today, he is having difficulty walking straight. Caller was seen by primary physician on about 8/2/10. MD offered no diagnosis or treatment and referred him to neurologist. Caller missed his appointment with neurologist and was seen at ER, where he was referred to his primary MD again. He was seen by primary MD this morning, and found to have 30% kidney function.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.