Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-2399

2. Registrant Information.

Registrant Reference Number: 1384470

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.

16-MAY-14

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

15-MAY-14

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.       PMRA Submission No.       EPA Registration No. 72155-86

Product Name: All-In-One Lawn Weed and Crabgrass Killer Ready-to-Spray

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
  • QUINCLORAC

---

7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

Unknown

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

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

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

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: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Edema

• Skin
  • Symptom - Blister
  • Symptom - Dry skin
  • Symptom - Tingling skin

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?

Unknown

7. Exposure scenario

Non-occupational

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

What was the activity? Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding the activity

Pesticide Spill

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

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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.)

5/16/2014 Caller accidentally got product on his hands 4 days ago. Caller was not wearing gloves and did not wash it off right away. He developed blisters on his hands 2 days later. He was unable to see his regular doctor, so he went to the emergency room. They drained the large blisters and wrapped them, and he also received a tetanus shot. Caller reports now that the smaller blisters are becoming larger. 5/20/2014 Caller has not gone to his doctor, and the blisters have become worse and full of blood. Caller has been applying hydrocortisone cream to the blisters. He has an appointment with his doctor in 3 days. 5/23/2014 Call back to the original caller for follow up information. A message was left requesting follow up. 5/24/2014 Caller still has blisters on his right hand only. Some of the blisters have healed, but some appear to be turning brown. His hand feels a bit swollen and he has a tingling sensation at times. He went to his doctor yesterday, and the doctor did not think there was any infection. The doctor prescribed Silvadine cream for application to the area and keeping the area clean. No follow up is scheduled at this time. 5/30/2014 Blisters continue to heal. He now has a crack in the skin, and still has a tingling sensation in his thumb and index finger. He has not been back to the doctor. Caller reports that the product was purchased in the United States and that the exposure occurred in Canada.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.