Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-6232

2. Registrant Information.

Registrant Reference Number: 3369798

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.

31-AUG-22

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

31-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. 33700      PMRA Submission No.       EPA Registration No.

Product Name: DECIS 100 EC INSECTICIDE

• Active Ingredient(s)
  • DELTAMETHRIN

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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: >12 <=19 yrs / >12 <=19 ans

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Corneal abrasion
  • Symptom - Irritated eye
  • Symptom - Pain

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

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

Other

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.

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.)

8/31/2022 Caller's employee was mixing the product with water this morning approximately 20 minutes prior to the call when the product either splashed or sprayed in the employee's eyes. He is unsure how exactly it happened, but the employee was not wearing a mask as he was supposed to be. The employee immediately began rinsing his eyes and is currently in the shower continuing to rinse. He does not wear contacts. By end of the conversation, caller stated that the employee has been rinsing for half an hour. He will take him to the emergency department as recommended, but they are half an hour away and his eyes are still quite painful. He wanted to know how can he treat the symptoms while on the way to the emergency department. 9/1/2022 Call back was attempted and spoke with caller. The patient was taken to emergency department, where his eye was rinsed again. They sent him home but made an early appointment with an ophthalmologist who he saw today. This doctor diagnosed an abrasion which he said would heal in 48-72 hours. He was prescribed an unknown eye drop, and advised to keep sunglasses on. Today the pain is resolved.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

A temporal relationship exists. The product is classified as an ocular corrosive on the SDS, and the type of effects experienced by the consumer are consistent with the reported exposure and subsequent findings by the evaluating ophthalmologist. Though there was no rechallenge, a probable relationship exists.