Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-5569

2. Registrant Information.

Registrant Reference Number: 5939905

Registrant Name (Full Legal Name no abbreviations): Bayer CropScienc Inc

Address: Suite 200, 160 Quarry Park Blvd SE

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.

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. 32073      PMRA Submission No.       EPA Registration No.

Product Name: Deflect Fungicide

• Active Ingredient(s)
  • METALAXYL
  • TEBUCONAZOLE

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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: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Erythema
  • Symptom - Flushed

4. How long did the symptoms last?

>30 min <=2 hrs / >30 min <=2 h

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

Unknown

6. a) Was the person hospitalized?

No

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.

<=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.)

05/23/18 10:32S: Caller's father got Deflect Fungicide on his finger through a hole in his glove. His finger is red but caller states the productitself is red and this is likely product residue. Caller denies any swelling, irritation, or itching.TOE: 15 minutes agoMed Hx: GH, no medications, NKAO: Dermal rednessA: Acute, adult, dermal exposure to Deflect Fungicide, SXSR: Consulted with CSPI S. RamsayWash product with soap and water.If sxs occur and persist, seek medical attention.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.