Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-6230

2. Registrant Information.

Registrant Reference Number: 3355558

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

Address: 160 Quarry Park Boulevard SE Suite 130

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.

15-AUG-22

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

13-AUG-22

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. 27487      PMRA Submission No.       EPA Registration No.

Product Name: ROUNDUP WEATHERMAX WITH TRANSORB 2 TECHNOLOGY LIQUID HERBICIDE

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS POTASSIUM SALT)

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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: Res. - Out Home / Rés - à l'ext.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?

Yes

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Female

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

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Edema

• Nervous and Muscular Systems
  • Symptom - Numbness

• Skin
  • Symptom - Irritated skin
  • Symptom - Tingling skin
  • Symptom - Burning skin

• Eye
  • Symptom - Swollen 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?

7. Exposure scenario

Non-occupational

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

Contact with treated area

What was the activity? Caller's wife was pulling weeds which had been sprayed with the product.

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

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.)

8/15/2022 Caller applied the product 3 to 5 weeks ago. Since using the product it has rained and the plants have died. Two days ago, his wife was pulling weeds from the area. She immediately began to feel tingling in her hands. She may have wiped her face with her hands, and has burning on her face and tingling on her lips. She thought the symptoms may have been from the sun, so she tried to stay out of the sun. Today she is improved, but her eyes are still puffy and she has burning under her eye. 8/16/2022 Call back from the original caller to provide product information. His wife has not seen her doctor as previously advised. She has only splashed water on her face as needed. Her lips are still tingling, but the burning sensation under her eyes is starting to subside. 8/19/2022 Call back to the original caller for follow up. His wife is doing well. He is not certain what symptoms remain, if any. She has not been seen yet. She made an appointment to see her doctor, but caller does not think she will go in.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.