Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2134

2. Registrant Information.

Registrant Reference Number: 2011-9

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.

18-MAY-11

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

10-MAY-11

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. 18836      PMRA Submission No.       EPA Registration No.

Product Name: Kumulus

• Active Ingredient(s)
  • SULPHUR

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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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Apples

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

Grower was applying to apples, exposure occurred to bystander who was approximately 3 feet away (blast);happened at 7:30PM May 10.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Sleepiness
  • Specify - Spent a great deal of time sleeping; concerned with what happened to lungs,bronchiole

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?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Drift from the application site

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.

Unknown

11. What was the length of exposure?

<=15 min / <=15 min

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.)

No specificity regarding symptoms, reporter expressed 'shock' at being sprayed with fungicide. Saw a doctor (presumably MD) who sent her for sputum and urinalysis tests; Saw naturopathic doctor a week later who provided a 'demulcifier' for 15 minutes and advised antioxidants, herbs and vitamins for 3 weeks.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

No specific symptom reported, so unclear if rates as 'minor'. Reporter was wearing undefined clothing (including shoes and hat) and removed clothing, showered immediately following exposure.