Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-5207

2. Registrant Information.

Registrant Reference Number: 856821

Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.

Address: 295 Henderson Drive

City: Regina

Prov / State: SK

Country: Canada

Postal Code: S4N 6C2

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

21-SEP-11

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

17-SEP-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. 27527      PMRA Submission No.       EPA Registration No.

Product Name: Compass 50WG

• Active Ingredient(s)
  • TRIFLOXYSTROBIN (CGA 279202)

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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: Pub. Area - Outdoor/Zone publique - ext

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.

Other

2. Demographic information of data subject

Sex: Female

Age: <=1 yr / < = 1 an

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Fever

• Skin
  • Symptom - Blister
  • Symptom - Erythema

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)

Contact with treated area

Amount of time between application and contact 1

Day(s) / Jour(s)

What was the activity? Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding the activity

Poisoning from ingestion of the pesticide

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.

Oral

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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.)

9/21/2011 Caller states that the product had been laid down on Friday afternoon on a putting green. She did not know this and let her 11 month old crawl on the green on Saturday afternoon. On Sunday the child was "cranky." Monday she developed a high fever. The fever broke and she developed red blisters inside her mouth, on Tuesday. The blisters then spread over her whole body. The areas that she would have contacted the product would be her knees, hands, and feet. Tues night they went into emergency, and they told her that the child probably had a virus and recommended treatment with acetaminophen. They did not do a culture of the sores or any tests.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.