Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-3374

2. Registrant Information.

Registrant Reference Number: ProPharma Group case#: 1-61794916

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.

28-JUL-20

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

28-JUL-20

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. 33009      PMRA Submission No.       EPA Registration No.

Product Name: VICTOR V FAST-KILL BRAND REFILLABLE BAIT STATION

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

---

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.

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

• Skin
  • Symptom - Tingling skin

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?

<=15 min / <=15 min

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.)

1-61794916- The reporter indicates an exposure to a pesticide containing the active ingredient diphacinone (present in free form or as sodium salt). Ten minutes before the time of initial contact, the reporter stated she opened the package of the product and touched one of the bait blocks, after which she washed her hands. The reporter indicated her fingers felt tingly but admitted it might be because she was nervous. The reporter was advised this would not be an expected symptom after touching the product, but to wash her hands thoroughly and seek medical attention should the symptom persist. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.