Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-5244

2. Registrant Information.

Registrant Reference Number: 1460943

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.

10-SEP-14

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

16-JUL-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)

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PMRA Registration No. 25673      PMRA Submission No.       EPA Registration No.

Product Name: Tempo 20 WP

• Active Ingredient(s)
  • CYFLUTHRIN

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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: Pub. Area - Indoor/Zone publique - int

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?

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: Female

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

3. List all symptoms, using the selections below.

System

• Cardiovascular System
  • Symptom - Hypertension
  • Symptom - Abnormally fast heart rate

• Gastrointestinal System
  • Symptom - Irritated throat

• Nervous and Muscular Systems
  • Symptom - Numbness

• Ear
  • Symptom - Ear irritation

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

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

Other

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.

Unknown

11. What was the length of exposure?

<=15 min / <=15 min

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.)

9/10/2014 Caller reports that product was applied by a pest control operator in her workplace on 7/19/2014. The product was applied in offices across the hall from her office, and shortly afterwards she developed throat and ear irritation. The following day she developed hypertension, increased heart rate, and numbness on the left side of her face. She was seen by a health care provider who referred her to a neurologist for evaluation. The neurologist said it was not a stroke, and she was referred to her primary physician. Her physician prescribed an antihistamine for treatment. She took a week off of work while cleaning was performed at her workplace. They symptoms improve, but worsen when she returns to her workplace.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.