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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-0834

2. Registrant Information.

Registrant Reference Number: 2666876

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.

11-MAY-20

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

11-MAY-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. 30102      PMRA Submission No.       EPA Registration No.

Product Name: Raxil Pro

  • Active Ingredient(s)
    • METALAXYL
      • Guarantee/concentration 6.2 g/L
    • PROTHIOCONAZOLE
      • Guarantee/concentration 15.4 g/L
    • TEBUCONAZOLE
      • Guarantee/concentration 3 g/L

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.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Nausea

4. How long did the symptoms last?

<=30 min / <=30 min

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

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.

Oral

Respiratory

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

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.)

5/11/2020 Caller purchased barley treated with the product. He was putting it in his tank when they had a break in the tank and he had to reach in there to close a door. This happened 20 to 30 minutes ago. There was some fine dust coming off of the barley, and he inhaled some through his nose and got some in his mouth. He immediately started to feel nausea. He rinsed his nostrils several times with saline and rinsed his eyes as a precaution. he felt like some of the dust was in the back of his throat, and he vomited one time. He has a sinus condition where his sinuses drain down his throat, and he is unsure if that was the reason he vomited. He is asymptomatic at this time.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.