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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2020-0482
2. Registrant Information.
Registrant Reference Number: 2019-125725
Registrant Name (Full Legal Name no abbreviations): Bayer Inc.
Address: 2920 Matheson Blvd East
City: Mississauga
Prov / State: Ontario
Country: Canada
Postal Code: L4W 5J4
3. Select the appropriate subform(s) for the incident.
Human
4. Date registrant was first informed of the incident.
28-JUN-195. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
Unknown
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)PMRA Registration No. 29497 PMRA Submission No. EPA Registration No.
Product Name: MUSKOL INSECT REPELLENT LOTION
- Active Ingredient(s)
- DEET (N,N-DIETHYL-M-TOLUAMIDE) PLUS RELATED ACTIVE TOLUAMIDES (ORTHO & PARA ISOMERS)
7. b) Type of formulation.
Application Information
8. Product was applied?
No
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: Female
Age: >64 yrs / > 64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Dizziness
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?
No
6. b) For how long?
7. Exposure scenario
Non-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.
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.)
This spontaneous case was reported by a consumer and describes the occurrence of DIZZINESS ('dizzy') in a female patient who received MUSKOL LOTION cutaneous emulsion. On 28JUN2019, a consumer spontaneously reported that she opened the packaging that contained the Muskol Lotion and the smell that came from opening the product caused her to become dizzy.
To be determined by Registrant
14. Severity classification.
Minor
