Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-1158

2. Registrant Information.

Registrant Reference Number: Rocky Mountain PC Case#: 6521563

Registrant Name (Full Legal Name no abbreviations): FMC Corporation

Address: 2929 Walnut Street

City: Philadelphia

Prov / State: Pennsylvania

Country: USA

Postal Code: 19104

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

Human

4. Date registrant was first informed of the incident.

08-MAR-22

5. Location of incident.

Country: UNITED STATES

Prov / State: ILLINOIS

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 279-9619

Product Name: Panoflex

• Active Ingredient(s)
  • THIFENSULFURON METHYL
    • Guarantee/concentration 10 %
  • TRIBENURON METHYL
    • Guarantee/concentration 40 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Glyphosate

• Active Ingredient(s)
  • GLYPHOSATE
    • Unknown

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7. b) Type of formulation.

Granular

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: corn and beans

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

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 - Irritated throat
  • Symptom - Other
  • Specify - Ulcers
  • Symptom - Other
  • Specify - Gastritis
  • Symptom - Other
  • Specify - Inflammted intestines

4. How long did the symptoms last?

>6 mos / > 6 mois

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

Yes

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

>1 yr / > 1 an

12. Time between exposure and onset of symptoms.

>6 mos / > 6 mois

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.)

Neighbor misused pesticides. Department of Agriculture found him guilty. The neighbor was not supposed to spray in over 10mile per hour winds but he does. Caller states he has been exposed to overspray since 2008. The neighbor stopped spraying 50 feet away from caller's property. He knows this is not far enough away from his property since they stop 100 feet away from the other neighbors in the area properties. He has had medical issues since 2013

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.