Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-2085

2. Registrant Information.

Registrant Reference Number: 2021-16

Registrant Name (Full Legal Name no abbreviations): BASF Canada Inc.

Address: 100 Milverton Drive, 5th Floor

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5R 4H1

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

06-MAY-21

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

05-MAY-21

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. 33210      PMRA Submission No.       EPA Registration No.

Product Name: Insure Cereal FX4

• Active Ingredient(s)
  • FLUXAPYROXAD
    • Guarantee/concentration 8.35 g/L
  • METALAXYL
    • Guarantee/concentration 10 g/L
  • PYRACLOSTROBIN
    • Guarantee/concentration 16.7 g/L
  • TRITICONAZOLE
    • Guarantee/concentration 16.7 g/L

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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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Barley seed

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Unknown

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

• Gastrointestinal System
  • Symptom - Sore throat

• Nervous and Muscular Systems
  • Symptom - Headache

• Respiratory System
  • Symptom - Chest congestion
  • Symptom - Nasal congestion
  • Symptom - Difficulty Breathing
  • Symptom - Runny nose

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.

Unknown

6. a) Was the person hospitalized?

Unknown

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.

Respiratory

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

>2 hrs <=8 hrs / > 2 h < = 8 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.)

Caller reports the product was applied to their barely seed 3 days ago. Caller was transferring the barley seed in the morning and inhaled a large amount of dust. He was fine until that evening when he developed a sore throat. Today, caller has been experiencing sore throat,HA, and difficulty breathing. He also reports his nose has been alternating between being runny and congested.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.