Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-2158

2. Registrant Information.

Registrant Reference Number: ProPharma Group case#: 1-52531965

Registrant Name (Full Legal Name no abbreviations): FMC Corporation

Address: 2929 Walnut Street

City: Philadelphia

Prov / State: Pennsylvania

Country: USA

Postal Code: 19104

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

Human

4. Date registrant was first informed of the incident.

25-MAY-18

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

24-MAY-18

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. 24175      PMRA Submission No.       EPA Registration No. Unknown

Product Name: DRAGNET FT EMULSIFIABLE CONCENTRATE INSECTICIDE

• Active Ingredient(s)
  • PERMETHRIN

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

Product Name: Lambdacide

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

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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 - Outdoor/Zone publique - ext

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

1-52531965 - The reporter indicated a non-registrant product called Lambdacide was applied at the same time as Dragnet. The application rate for Lambdacide is not known.

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.

Other

2. Demographic information of data subject

Sex: Female

Age: >1 <=6 yrs / > 1 < = 6 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Rash

4. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Contact with treated area

What was the activity? The data subject was walking to preschool.

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

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

1-52531965 - The reporter indicated her daughter was exposed to a pesticide containing the active ingredient permethrin. One day before the day of initial contact with the registrant, the reporter indicated the product had been sprayed outside of her daughter's preschool. On the day of initial contact with the registrant, the reporter indicated she was dropping off her daughter at preschool and the child reached down into a clump of dirt that had been sprayed. Within a couple of minutes, the child developed a rash on her hand which remained even after her hand had been thoroughly rinsed. The reporter was advised to rinse the exposed area for at least 20 minutes and to seek medical care if the symptom persisted. On follow-up call four days later, the reporter indicated the rash had gone away within 24 hours. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.