Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-4276

2. Registrant Information.

Registrant Reference Number: ProPharma Group case#: 1-53650556

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.

17-AUG-18

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

17-AUG-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. 24359      PMRA Submission No.       EPA Registration No.

Product Name: GLYFOS SOLUBLE CONCENTRATE HERBICIDE

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)

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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).

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

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing

• Eye
  • Symptom - Irritated eye

• Respiratory System
  • Symptom - Shortness of breath
  • Symptom - Irritated nose
  • Symptom - Irritated throat

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Diarrhea

• Skin
  • Symptom - Irritated skin

• Nervous and Muscular Systems
  • Symptom - Headache

• General
  • Symptom - Lethargy

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?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Application

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

Eye

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.)

1-53650556 - The reporter indicated an exposure to a pesticide containing the active ingredient glyphosate (present as isopropylamine salt or ethanolamine salt). On the day of initial contact with the registrant, the reporter indicated was accidently sprayed with the product while out in public and sustained dermal contact, ocular contact and inhalation of vapors. An unknown amount of time later he developed a cough, respiratory irritation, dermal irritation, ocular irritation, vomiting, and shortness of breath. The reporter indicated he had sought fresh air, showered, and rinsed his eyes. The reporter was advised to seek medical attention due to the persistence and severity of his symptoms. On follow-up call one day later, the reporter indicated he had sought medical attention as he had developed diarrhea, headache, and lethargy in addition to his other symptoms. The reporter was told by doctors that there was nothing they could do for the symptoms other than let the product work through his system. On follow-up call four days after the day of initial contact, the reporter indicated his symptoms were about the same. The reporter was advised to continue to work with his doctor. No additional information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.