Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-2159

2. Registrant Information.

Registrant Reference Number: ProPharma Group case#: 1-52516465

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.

24-MAY-18

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

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. 28573      PMRA Submission No.       EPA Registration No. Unknown

Product Name: AIM EC HERBICIDE

• Active Ingredient(s)
  • CARFENTRAZONE-ETHYL

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7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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).

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: Male

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

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Bleeding
  • Symptom - Pain

• General
  • Symptom - Swelling

• Nervous and Muscular Systems
  • Symptom - Numbness

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?

7. Exposure scenario

Occupational

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

Other

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.)

1-52516465 - The reporter indicated her husband was exposed to a pesticide containing the active ingredient carfentrazone-ethyl. Four hours before the time of initial contact with the registrant, the reporter indicated her husband was placing a bottle of the concentrate on a spike when he slipped and the spike stabbed through the nailbed of one of his fingers getting some of the concentrate in the wound. The reporter indicated her husband immediately had pain and bleeding, followed by numbness and swelling. The reporter was advised to seek immediate medical evaluation for her husband due to the potential for infection and tissue damage. The reporter was not available on follow-up call two days later. On follow-up call four days after the day of initial contact, the reporter indicated her husband had not sought medical care because he was too busy, but there were flare-ups of his symptoms. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.