Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2254

2. Registrant Information.

Registrant Reference Number: 12052501

Registrant Name (Full Legal Name no abbreviations): Nufarm Agriculture Inc.

Address: 5507 1st Street SE

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2H 1H9

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

Human

4. Date registrant was first informed of the incident.

25-MAY-12

5. Location of incident.

Country: CANADA

Prov / State: UNKNOWN

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. 9342      PMRA Submission No.       EPA Registration No.

Product Name: NUFARM CALMIX PELLETS WEED KILLER SOIL STERILANT

• Active Ingredient(s)
  • 2,4-D (PRESENT AS ACID)
  • BROMACIL (PRESENT IN FREE FORM, AS DIMETHYLAMINE SALT, OR AS LITHIUM SALT)

---

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

15

Units: kg

10. Site pesticide was applied to (select all that apply).

Site: Unknown / Inconnu

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

The product was applied, it was raining and visible ground water was present. Broadcast application with a hand-held seed broadcast spreader. 15 kg of product was applied in 2.5 hours. Rubber boots and appropriate work clothes were worn. As soon as he finished applying the symptoms began to develop.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Malaise
  • Specify - feeling sick

• Respiratory System
  • Symptom - Sinus pain
  • Specify - sinuses were throbbing

• Nervous and Muscular Systems
  • Symptom - Headache

• Respiratory System
  • Symptom - Shortness of breath

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

>2 hrs <=8 hrs / >2 h <=8 h

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 h

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.)

15 kg of product was applied during 2.5 hours. Right after application the symptoms began to show up. Went home took some Reactine and pain medication and slept for 3 hours. The next day he was supposed to go to the Doctor.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Applicator did not follow product's label directions.