Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3174

2. Registrant Information.

Registrant Reference Number: 795753

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.

30-MAY-11

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

10-MAR-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. 18022      PMRA Submission No.       EPA Registration No.

Product Name: BUCTRIL M HERBICIDE(Canada)

• Active Ingredient(s)
  • BROMOXYNIL
  • MCPA (PRESENT AS ESTERS)

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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: Unknown

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: Female

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Irritated throat

• Skin
  • Symptom - Rash

4. How long did the symptoms last?

>2 mos and <=6mos />2 mois et <=6mois

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

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)

None

10. Route(s) of exposure.

Skin

Respiratory

11. What was the length of exposure?

<=15 min / <=15 min

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.)

5/30/2011 Caller states she is a biologist and she was inadvertently over-sprayed with the product on 3/10/11 as a farmer passed within 4 feet of her in a field while spraying. The caller states she developed a burning sensation in her throat within minutes after the exposure and states it subsided within 10 minutes, by sipping water. The caller states later that night a red, raised rash developed on her chest, despite removing all affected/contaminated clothing and laundering/ showering after the initial exposure. The caller saw her MD several days later and he was unsure of the etiology of the rash. No treatments or medications were prescribed by the doctor. The rash finally subsided around 5/23/11.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.