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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-2749

2. Registrant Information.

Registrant Reference Number: Rocky Mountain PC Case#: 6559442

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.


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: NEBRASKA

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 279-9596

Product Name: Steward EC

  • Active Ingredient(s)

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.

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).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


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.


  • Nervous and Muscular Systems
    • Symptom - Paralysis
  • Gastrointestinal System
    • Symptom - Vomiting
  • Respiratory System
    • Symptom - Coughing
    • Symptom - Wheezing
  • General
    • Symptom - Pain
    • Specify - Pain up to shoulder
    • Symptom - Other
    • Specify - Wrist sags

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.


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


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


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


10. Route(s) of exposure.




11. What was the length of exposure?

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

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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 works for Westco for westward aviation. on 6/4/22 there was a shuttle full of insecticide and there is a meter and the seal around that meter blew and he was soaked with the insecticide. Scrubbed arms then drove 20" to his home where he showered. inhalation exposure while driving. dermal exposure for 30" until he showered. emt came to his home and checked him out and recommended he go to er. htn, on bp medson 6/7 [Name], manager sent him home from work because of his sx. [Name] was there as well. on 6/10 was talking to neighbor and he lost control of left arm. He thought he was having a stroke, bp was 228/118 so neighbor drove him to ER. he can move index finger and thumb. Wrist sags. pain up to shoulder. Saw Dr [Name], caller told him about the exposure. MRI on chest for wheezing in left lung. They just sent him home with a splint for his arm. yesterday Dr rx albuterol. xray pending on wrist may have a fx. still cannot use his left arm. PCP is Dr [Name] is the one who is getting him in to see neurologist. Dr increased the dose of his bp meds. He is a single father and just wanted to make money. So was trying to work but everyday he has these episodes of coughing/vomiting.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.