Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-4620

2. Registrant Information.

Registrant Reference Number: 1673008

Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.

Address: 160 QUARRY PARK BLVD. SE Suite 200

City: CALGARY

Prov / State: AB

Country: Canada

Postal Code: T2C 3G3

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

Human

4. Date registrant was first informed of the incident.

25-AUG-15

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

07-JUN-15

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.       PMRA Submission No.       EPA Registration No. 432-1483

Product Name: Temprid SC Insecticide

• Active Ingredient(s)
  • CYFLUTHRIN
    • Guarantee/concentration 10.5 %
  • IMIDACLOPRID
    • Guarantee/concentration 21 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 432-772

Product Name: DeltaDust 1 lb

• Active Ingredient(s)
  • DELTAMETHRIN
    • Guarantee/concentration .05 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 65733-18-8

Product Name: Gentrol IGR Concentrate with Gentrol Insect Growth Regulator

• Active Ingredient(s)

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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).

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.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Nausea
  • Symptom - Vomiting

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

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.

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.)

8/25/2015 The following report was forwarded for documentation. The report states that earlier today caller phoned regarding an investigation. On 6/2/2015 a pest control company applied the products. On 6/7/2015, one of the residents died. An autopsy was done and they are awaiting results. The care giver of the resident thought there was a strong odor, and was treated at the hospital for nausea and vomiting. There is an ongoing investigation until they get the coroner's report. They do not feel that it is related to the use of the products.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Death

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Unknown

6. a) Was the person hospitalized?

Unknown

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

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?

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.)

8/25/2015 The following report was forwarded for documentation. The report states that earlier today caller phoned regarding an investigation. On 6/2/2015 a pest control company applied the products. On 6/7/2015, one of the residents died. An autopsy was done and they are awaiting results. The care giver of the resident thought there was a strong odor, and was treated at the hospital for nausea and vomiting. There is an ongoing investigation until they get the coroner's report. They do not feel that it is related to the use of the products.

To be determined by Registrant

14. Severity classification.

Death

15. Provide supplemental information here.