Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-1901

2. Registrant Information.

Registrant Reference Number: 766252

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.

22-MAR-11

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

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)

---

PMRA Registration No. 25673      PMRA Submission No.       EPA Registration No.

Product Name: Tempo WP

• Active Ingredient(s)
  • CYFLUTHRIN

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Demand (non-Bayer product)

• Active Ingredient(s)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Other unspecified insecticides

• Active Ingredient(s)

---

7. b) Type of formulation.

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

• Ear
  • Symptom - Tinnitus

• Nervous and Muscular Systems
  • Symptom - Headache
  • Symptom - Muscle tremors
  • Symptom - Muscle weakness

4. How long did the symptoms last?

Unknown / Inconnu

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

No

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)

Chemical resistant gloves

Coveralls (non-chemical resistant)

Respirator

10. Route(s) of exposure.

Skin

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.)

3/22/2011 Caller is a pest control officer, and has been in practice for over 10 years. Caller mainly uses these two products for application, but also uses various other products. Caller usually wears coveralls, gloves, and a respirator while he is working, but sometimes does have direct contact with the products. About two months ago, caller developed tinnitus and recurring headaches. Caller now has developed tremors and weakness in his legs over the past month. Caller did see his doctor for these symptoms a week ago, but a cause has not been ascertained nor has any specific treatments been applied.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.