Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-1339

2. Registrant Information.

Registrant Reference Number: 2019-9c

Registrant Name (Full Legal Name no abbreviations): BASF Canada Inc.

Address: 100 Milverton Drive 5th Floor

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5R 0E4

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

Human

4. Date registrant was first informed of the incident.

28-FEB-19

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

22-FEB-19

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. 28485      PMRA Submission No.       EPA Registration No.

Product Name: 221 Residual Insecticide

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

---

PMRA Registration No. 30075      PMRA Submission No.       EPA Registration No.

Product Name: Bedlam

• Active Ingredient(s)
  • D-PHENOTHRIN
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE

---

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

Product Name: Temprid

• Active Ingredient(s)
  • BETA-CYFLUTHRIN
  • IMIDACLOPRID

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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).

221 Residual insecticide was applied with Temprid around the baseboards. Bedlam was sprayed on the couch,

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.

Medical Professional

2. Demographic information of data subject

Sex: Male

Age: >12 <=19 yrs / >12 <=19 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Muscle pain

• General
  • Symptom - Other
  • Specify - Exacerbation of Fuzzy head/ buzzing in head

• Nervous and Muscular Systems
  • Symptom - Difficulty walking
  • Symptom - Headache

4. How long did the symptoms last?

Unknown / Inconnu

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

No

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)

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

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

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.)

From report: Caller and 2 sons have multiple medical conditions and all 3 have sensitivities to chemicals and fragrances. Yesterday a pest control company use this product along with 2 other unknown products in caller's apartment. She waited for 7 hours and then returned home with both children. The product was dry but she noticed an odor. Within a couple of hours caller developed a headache, cough,dizziness, resting heart rate elevation (120 bpm), shakiness and became more forgetful. These symptoms have persisted in differing severity. She slept on a couch that is believed to have had this product used on it. Her sons also stayed in the home. One has been drowsy and maybe confused. He is just not acting himself. The other son has a preexisting condition that is described as a fuzzy/buzzing in his head. This condition has worsened as he has reentered the home. He has also been dealing with headaches, trouble walking and his muscles are more sore than usual. Caller states that they have had similar reactions before in similar situations but this time their symptoms are worse then expected. She states that even Tylenol has not helped her headache. She is in the process of finding out what the 2 other product are. Caller would like to know of any poisoning concerns and what to do. She states that they are planning on coming back and using the product again. They have not left the home at this point and have not called their physician. Follow up call: Callback completed. Spoke to the initial caller. She reports that she found information about the other products that were used in the home, Bedlam was sprayed on the couch, and Temprid was used around the baseboards along with the 221 Residual Spray product. She continues to have symptoms inside her home, but the symptoms dissipate when she leaves. She has been in contact with the PCP,and they have given her instructions to reduce their exposure to the products. She has not sought medical attention, but plans to speak to their physician about possible effects from their exposure.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Source of report is family member of data subject. As per report, specialist stated "There is not typical or expected reactions to use of the product. As long as the product was dry and ventilated we would not expect any symptoms to develop. However, different people can have different sensitivities to different products and sometimes unusual thing can happed..."

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: Female

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

3. List all symptoms, using the selections below.

System

• Cardiovascular System
  • Symptom - Abnormally fast heart rate

• Gastrointestinal System
  • Symptom - Nausea

• Nervous and Muscular Systems
  • Symptom - Headache

• General
  • Symptom - Other
  • Specify - Forgetfulness

• Nervous and Muscular Systems
  • Symptom - Dizziness

• Respiratory System
  • Symptom - Coughing

• Nervous and Muscular Systems
  • Symptom - Shaking
  • Symptom - Trembling

4. How long did the symptoms last?

Unknown / Inconnu

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

No

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)

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

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

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.)

From report: Caller and 2 sons have multiple medical conditions and all 3 have sensitivities to chemicals and fragrances. Yesterday a pest control company use this product along with 2 other unknown products in caller's apartment. She waited for 7 hours and then returned home with both children. The product was dry but she noticed an odor. Within a couple of hours caller developed a headache, cough,dizziness, resting heart rate elevation (120 bpm), shakiness and became more forgetful. These symptoms have persisted in differing severity. She slept on a couch that is believed to have had this product used on it. Her sons also stayed in the home. One has been drowsy and maybe confused. He is just not acting himself. The other son has a preexisting condition that is described as a fuzzy/buzzing in his head. This condition has worsened as he has reentered the home. He has also been dealing with headaches, trouble walking and his muscles are more sore than usual. Caller states that they have had similar reactions before in similar situations but this time their symptoms are worse then expected. She states that even Tylenol has not helped her headache. She is in the process of finding out what the 2 other product are. Caller would like to know of any poisoning concerns and what to do. She states that they are planning on coming back and using the product again. They have not left the home at this point and have not called their physician. Follow up call: Callback completed. Spoke to the initial caller. She reports that she found information about the other products that were used in the home, Bedlam was sprayed on the couch, and Temprid was used around the baseboards along with the 221 Residual Spray product. She continues to have symptoms inside her home, but the symptoms dissipate when she leaves. She has been in contact with the PCP,and they have given her instructions to reduce their exposure to the products. She has not sought medical attention, but plans to speak to their physician about possible effects from their exposure.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

As per report, specialist stated "There is not typical or expected reactions to use of the product. As long as the product was dry and ventilated we would not expect any symptoms to develop. However, different people can have different sensitivities to different products and sometimes unusual thing can happed..."

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: >12 <=19 yrs / >12 <=19 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Confusion

• General
  • Symptom - Drowsiness
  • Symptom - Lethargy
  • Symptom - Abnormal behaviour

4. How long did the symptoms last?

Unknown / Inconnu

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

No

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)

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

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

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.)

From report: Caller and 2 sons have multiple medical conditions and all 3 have sensitivities to chemicals and fragrances. Yesterday a pest control company use this product along with 2 other unknown products in caller's apartment. She waited for 7 hours and then returned home with both children. The product was dry but she noticed an odor. Within a couple of hours caller developed a headache, cough,dizziness, resting heart rate elevation (120 bpm), shakiness and became more forgetful. These symptoms have persisted in differing severity. She slept on a couch that is believed to have had this product used on it. Her sons also stayed in the home. One has been drowsy and maybe confused. He is just not acting himself. The other son has a preexisting condition that is described as a fuzzy/buzzing in his head. This condition has worsened as he has reentered the home. He has also been dealing with headaches, trouble walking and his muscles are more sore than usual. Caller states that they have had similar reactions before in similar situations but this time their symptoms are worse then expected. She states that even Tylenol has not helped her headache. She is in the process of finding out what the 2 other product are. Caller would like to know of any poisoning concerns and what to do. She states that they are planning on coming back and using the product again. They have not left the home at this point and have not called their physician. Follow up call: Callback completed. Spoke to the initial caller. She reports that she found information about the other products that were used in the home, Bedlam was sprayed on the couch, and Temprid was used around the baseboards along with the 221 Residual Spray product. She continues to have symptoms inside her home, but the symptoms dissipate when she leaves. She has been in contact with the PCP,and they have given her instructions to reduce their exposure to the products. She has not sought medical attention, but plans to speak to their physician about possible effects from their exposure.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Source of report is family member of data subject. As per report, specialist stated "There is not typical or expected reactions to use of the product. As long as the product was dry and ventilated we would not expect any symptoms to develop. However, different people can have different sensitivities to different products and sometimes unusual thing can happed..."