Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-5169

2. Registrant Information.

Registrant Reference Number: 2603153

Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.

Address: 160 QUARRY PARK BLVD. SE Suite 200

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.

30-JAN-20

5. 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)

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PMRA Registration No. 32524      PMRA Submission No.       EPA Registration No.

Product Name: TEMPRID SC INSECTICIDE

• Active Ingredient(s)
  • BETA-CYFLUTHRIN
    • Guarantee/concentration 10.5 %
  • IMIDACLOPRID
    • Guarantee/concentration 21 %

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7. b) Type of formulation.

Liquid

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).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Yes

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

• General
  • Symptom - Edema
  • Specify - Swelling under eyes

• Respiratory System
  • Symptom - Shortness of breath

• Skin
  • Symptom - Irritated skin
  • Symptom - Rash
  • Symptom - Burning skin
  • Specify - Face had a burning sensation

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

Unknown

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Contact with treated area

Amount of time between application and contact 24

Hour(s) / Heure(s)

What was the activity? Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding the activity

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.

Unknown

11. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

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.)

1/30/2020 Caller reports that this product was applied in her brother's apartment by a pest control company on 1/24/2020. Her brother left the home that day, and returned 24 hours later. The product was sprayed all over, and the residue was on his computer and television. He wiped the surfaces down and then washed his hands. As soon as he walked in the door experienced a rash on his arms, legs, and face. He had shortness of breath. His face started to swell under his eyes, and his whole face had a burning sensation. He went to a walk in clinic this morning. the doctor told him he had chemical burns on his face. He was prescribed a medication, but he cannot afford it and has not picked it up. He was also given an inhaler for the shortness of breath. He has remained in the home since 1/25/2020. 1/31/2020 Call back to the original caller for follow up. Her brother was seen by his family doctor yesterday, and was told he had a severe allergic reaction. He was given several unknown medications, both topical and oral.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Given the signs and symptoms occurred immediately upon re-entry to where the product was applied, a temporal relationship exists. While the product is not a known sensitizer, allergic reaction cannot be ruled out. All other differential diagnoses or causes of the allergic reaction have not be ruled out and allergy testing would be required to determine what may have caused the allergic reaction. No re-challenge occurred.