Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-0528

2. Registrant Information.

Registrant Reference Number: 2014-3

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

Address: 100 Milverton, 5th floor

City: Mississauaga

Prov / State: Ontario

Country: Canada

Postal Code: L5R 4H1

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

Human

4. Date registrant was first informed of the incident.

06-FEB-14

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

25-JUL-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)

---

PMRA Registration No. 27321      PMRA Submission No.       EPA Registration No.

Product Name: Headline and Twinline

• Active Ingredient(s)
  • PYRACLOSTROBIN

---

PMRA Registration No. 29766      PMRA Submission No.       EPA Registration No.

Product Name: Caramba (29767) and Twinline

• Active Ingredient(s)
  • METCONAZOLE

---

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: unknown

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

Custom sprayer used products Caramba, Twinline, Headline and several other fungicides and herbicides that he could not remember names.Used products over several months, most recently July, 2013. Approx July 25 developed symptoms

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.

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

• Respiratory System
  • Symptom - Respiratory congestion
  • Symptom - Sneezing

4. How long did the symptoms last?

>6 mos / > 6 mois

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)

Application

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Chemical resistant gloves

Chemical resistant coveralls

Respirator

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>1 wk <=1 mo / > 1 sem < = 1 mois

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.)

Developed congestion, sneezing....sneezing fits initially every 3 days, dropped later to 1x per week. treated with OTC anti-histamine, didn't see MD. Wore full PPE as per labels....mentioned use of 'mask', assumed respirator.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

did not get MD assessment. Used a range of products, followed labels for PPE