Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-0827

2. Registrant Information.

Registrant Reference Number: 926134

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.

08-FEB-12

5. Location of incident.

Country: UNITED STATES

Prov / State: VIRGINIA

6. Date incident was first observed.

07-FEB-12

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. 432-7483

Product Name: Temprid SC Insecticide

• Active Ingredient(s)
  • BETA-CYFLUTHRIN
    • Guarantee/concentration 10.5 %
  • IMIDACLOPRID
    • Guarantee/concentration 21 %

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7. b) Type of formulation.

Liquid

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).

Product was applied to a residential structure by a pest control professional

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: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Dizziness

• Gastrointestinal System
  • Symptom - Nausea

4. How long did the symptoms last?

Persisted until death

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

Unknown

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)

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?

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.)

02/07/2012 Caller is a pest control professional, who was contacted by a female client on 2/2/12 to complain that since her house (interior) was treated with product on 1/18/12, there had been staining on the premises, and she had been feeling nauseated and light-headed. She seemed more concerned with the staining on the floor. Caller spoke to the female client's husband (name) today, and husband informed him that she had died - "over the weekend". Caller wishes to report this incident. Case to tox. _______________________________________________________________________________________________________________________________ 02/07/12 Spoke with initial caller - reports that treatment with Temprid was done on or about 18JAN2012 by PCO. According to paperwork this was a "crack and crevasse" treatment in the kitchen. bathroom, living room bedroom and the pipe chases throughout the structure. His firm was initially contacted on or about 2FEB2012 by (name) (primarily) to report problems with "staining" around the home. She had may off hand comments at that time about complaints of dizziness and nausea. Staff had requested they schedule a follow up with her to come and assess the premises and to consider clean up of any stained areas. She had agreed but had specifically noted that she had not wanted husband to be made aware of her call to them (the PCO). Printed 2/7/2012 1:04 PM Page: 1 of 2 His firm was initially contacted on or about 2FEB2012 by (name) (primarily) to report problems with "staining" around the home. She had may off hand comments at that time about complaints of dizziness and nausea. Staff had requested they schedule a follow up with her to come and assess the premises and to consider clean up of any stained areas. She had agreed but had specifically noted that she had not wanted husband to be made aware of her call to them (the PCO). (name) called this morning to set up the appointment and was informed by husband that she had died over this past weekend. No further details are known. According to his staff that had done the treatment at her home, she was an "elderly" woman though nothing else is known.

To be determined by Registrant

14. Severity classification.

Death

15. Provide supplemental information here.

According to the information received, the application was a crack and crevice treatment. This type of application minimizes the potential for any exposure to the product. Therefore, in our opinion, the cause of death is independent of any exposure to this product, and the apparent temporal association is purely coincidental. Not only was there no allegation from the deceased s family that the product was involved, but the notice of death was only obtained by a follow-up contact by the PCO to the deceased s family to address unrelated issues.