Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2388

2. Registrant Information.

Registrant Reference Number: 2012-17

Registrant Name (Full Legal Name no abbreviations): BASF Canada

Address: 100 Milverton,5

City: Mississauaga

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.

28-JUN-12

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

28-JUN-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. 29767      PMRA Submission No.       EPA Registration No.

Product Name: Caramba

• Active Ingredient(s)
  • METCONAZOLE

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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: wheat

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

4 individuals standing in wheat field, taking samples, told by farmer it had just been sprayed. Wearing short sleeves, dermal exposure, one wiped face, eye irritation ensued.

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: Male

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

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Erythema
  • Symptom - Pruritus
  • Symptom - Rash

• Eye
  • Symptom - Irritated eye
  • Symptom - Pain

• Skin
  • Symptom - Hives

4. How long did the symptoms last?

Unknown / Inconnu

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

Occupational

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

Contact with treated area

Amount of time between application and contact 2

Hour(s) / Heure(s)

What was the activity? taking plant samples, standing among plants

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

Eye

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

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.)

2 of 4 dialed in with symptoms. one rubbed eye and got eye irritation, showered, eye irritation persisted.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.