Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-0842

2. Registrant Information.

Registrant Reference Number: 2695403

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.

03-JUL-20

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

03-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)

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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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PMRA Registration No. 15255      PMRA Submission No.       EPA Registration No.

Product Name: DRIONE INSECTICIDE POWDER

• Active Ingredient(s)
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration 9.7 %
  • PYRETHRINS
    • Guarantee/concentration 1 %
  • SILICA AEROGEL
    • Guarantee/concentration 40 %

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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).

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?

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

• Gastrointestinal System
  • Symptom - Irritated throat

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)

Other

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.

Respiratory

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.)

6/17/2020 Caller reports that a pest control operator will be applying the first product in her apartment on 6/18/2020. She is looking for information about the product. 7/3/2020 Call back from the original caller. She never had any issues from the first treatment. A pest agent came and did a second treatment with the second product today. She had to be out of the residence for 2 hours after treatment. When she re-entered she noticed dust residue on certain surfaces. She may have gotten a small amount of the dust on her hand. She mentioned having minor throat irritation after being in her room.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.