Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-5397

2. Registrant Information.

Registrant Reference Number: ProPharma Group case#: 1-54047100

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

Address: 620 Lesher Place

City: Lansing

Prov / State: Michigan

Country: USA

Postal Code: 48912

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

Human

4. Date registrant was first informed of the incident.

20-SEP-18

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

20-SEP-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. 30167      PMRA Submission No.       EPA Registration No. Unknown

Product Name: RAMIK BARS KILLS RATS AND MICE

• Active Ingredient(s)
  • DIPHACINONE (PRESENT IN FREE FORM OR AS SODIUM 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: 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).

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

• Nervous and Muscular Systems
  • Symptom - Dizziness

• Skin
  • Symptom - Tingling skin
  • Symptom - Other
  • Specify - numbness (lip)

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

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

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.)

1-54047100 - The reporter indicates an exposure to a pesticide containing the active ingredient diphacinone. On the day of initial contact with the registrant, the reporter indicated her husband was placing the product in the home and accidently touched his lips after handing the product. The reporter indicated within ten minutes of the described contact her husband's lips were numb and he felt dizzy. The report was advised these symptoms were unlikely to be related to the exposure to the product, but he should thoroughly wash his hands and face. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.