Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-0843

2. Registrant Information.

Registrant Reference Number: 2710831

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.

06-JUL-20

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

06-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.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Priaxor

• Active Ingredient(s)

---

PMRA Registration No. 31533      PMRA Submission No.       EPA Registration No.

Product Name: DELARO 325 SC FUNGICIDE

• Active Ingredient(s)
  • PROTHIOCONAZOLE
    • Guarantee/concentration 175 g/L
  • TRIFLOXYSTROBIN (CGA 279202)
    • Guarantee/concentration 150 g/L

---

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: Other / Autre

Préciser le type: Workplace

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

• Skin
  • Symptom - Irritated skin
  • Symptom - Pruritus

• Nervous and Muscular Systems
  • Symptom - Dizziness

4. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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)

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

Respiratory

11. What was the length of exposure?

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

12. Time between exposure and onset of symptoms.

>8 hrs <=24 hrs / > 8 h < = 24 h

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.)

7/6/2020 Caller was working with the diluted product this morning and also a second product this evening while at work. She was mixing the product, and it splashed onto her face and arms. She also feels like she inhaled a lot of the product today. The product was on her skin for approximately 30 minutes to an hour before washing it off. She has not showered. She is experiencing itching and irritation on her skin. She has had water to drink and has taken a nap. She can smell the product now and is experiencing dizziness. Caller abruptly disconnected. Attempted call back to the original caller. Left a message for caller to follow up. 7/14/2020 Call back to the original caller. She rinsed her skin and got fresh air. The symptoms resolved that same evening.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.