Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-3827

2. Registrant Information.

Registrant Reference Number: 2985375

Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.

Address: Suite 130, 160 Quarry Park Boulevard SE

City: CALGARY

Prov / State: AB

Country: Canada

Postal Code: T2C 3G3

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

Human

Packaging Failure

4. Date registrant was first informed of the incident.

18-JUN-21

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

18-JUN-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. 22659      PMRA Submission No.       EPA Registration No.

Product Name: THUMPER EMULSIAFIABLE SELECTIVE WEEDKILLER

• Active Ingredient(s)
  • 2,4-D (PRESENT AS LOW VOLATILE ESTERS)
    • Guarantee/concentration 280 g/L
  • BROMOXYNIL
    • Guarantee/concentration 280 g/L

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

Unknown

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).

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.

Other

2. Demographic information of data subject

Sex: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Irritated eye

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

6. a) Was the person hospitalized?

No

6. b) For how long?

Unknown

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

What was the activity? Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding the activity

Pesticide Spill

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

Eye

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.)

6/18/2021 Caller's husband was working with the product 20 minutes ago when the container of the product broke and splashed liquid onto his face and eyes. He denies getting the product in his mouth. He developed irritation in his eyes immediately. He rinsed for 15 minutes prior to the call. He was not wearing contact lenses at the time of the exposure.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

A strong temporal relationship exists between the product exposure and the onset of symptoms. The product can cause mild irritation to the eye with inadvertent exposures. An increase in irritation may occur with irrigation of the eye with water that is expected to be mild in nature and self limiting. Symptoms resolved with removal from the exposure and decontamination. No re-challenge occurred and would not be recommended.

Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Unknown / Inconnu

2. Did packaging failure occur during?

Other

specify Unspecified working with the product

3. Did packaging failure result in?

potential exposure

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

6/18/2021 Caller's husband was working with the product 20 minutes ago when the container of the product broke and splashed liquid onto his face and eyes. He denies getting the product in his mouth. He developed irritation in his eyes immediately. He rinsed for 15 minutes prior to the call. He was not wearing contact lenses at the time of the exposure.

For Registrant use only

5. Provide supplemental information here.