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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-0850

2. Registrant Information.

Registrant Reference Number: 2825317

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-DEC-20

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

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)

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 %

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: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

  • Cardiovascular System
    • Symptom - Chest pain
  • General
    • Symptom - Sweating
  • Skin
    • Symptom - Other
    • Specify - Clammy hands

4. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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

Yes

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)

Contact with treated area

What was the activity? Accidentally touching a treated couch.

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.

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.)

12/4/2020 Caller's condo was treated for bed bugs yesterday by a pest control operator. The product was sprayed on a sectional couch, and one of the sections was moved near a light switch. Caller's had accidentally touched the couch while turning off the light switch approximately 10 minutes after it was sprayed. He washed his hands 4 times. His hands have been sweaty and clammy, and he is not sure if it is from the product or from health related anxiety.2/17/2021 Call back from the original caller. He has not lived in his apartment for 2 months. He states he is having sweaty hands. 2/19/2021 Call back from the original caller. Caller is requesting reassurance about his initial exposure. He denies any ongoing symptoms. He confirms that the initial symptoms reported resolved after 1 week on their own. He consulted his doctor 2 months ago, and was told that there was no concern. He also spoke to poison control who told him the described exposure is not of concern. He explains he has healthy anxieties, and had a panic attack last week about the previous exposure.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.