Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5482

2. Registrant Information.

Registrant Reference Number: 13093001

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.

10-OCT-13

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

20-AUG-13

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. 27968      PMRA Submission No.       EPA Registration No.

Product Name: ESTAPROP PLUS LIQUID HERBICIDE

• Active Ingredient(s)
  • 2,4-D (PRESENT AS LOW VOLATILE ESTERS)
  • DICHLORPROP (PRESENT AS BUTOXYETHYL ESTER, AS ISOOCTYL ESTER, OR AS ETHYLHEXYL ESTER)

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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: 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).

Applications started the end of June, there was a period of about a month and a half when she was applying the diluted product daily. A hand sprayer was used.

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: Female

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

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Joint pain

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)

Application

Drift from the application site

Pesticide Spill

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.

Skin

Respiratory

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.)

While using the hand sprayer, some product dripped out on her hands; she also states that she likely inhaled some of the product. About 1.5 months later (8/20) she started developing pain in her shoulder joints and her wrist joints. On 8/25 she stopped using the product as the pain in her shoulder and wrist joints had become severe. Caller states that about 2 weeks ago she went to her doctor who ran a couple of blood tests looking for arthritis from a virus, etc. Anti-inflammatory medication was prescribed.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Not-labelled use of the product.