Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-2263

2. Registrant Information.

Registrant Reference Number: Rocky Mountain PC Case#: 6684961

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.

31-MAY-23

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

30-MAY-23

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. 34385      PMRA Submission No.       EPA Registration No.

Product Name: Coragen Max

• Active Ingredient(s)
  • CHLORANTRANILIPROLE

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

Product Name:

• Active Ingredient(s)

---

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: Other / Autre

Préciser le type: Occupational

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

Caller was spraying products at work, during application he spilled them on his hands and forearms.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Diarrhea
  • Symptom - Stomach pain

4. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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

No

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)

Application

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

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>2 hrs <=8 hrs / > 2 h < = 8 h

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.)

Did not seek medical care.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

The Hotline was contacted at 8:52 AM today (5/31/23) by [Name]. He was spraying Coragen Max last night when he had an accidental spill the covered him with Coragen Max. He showered and cleaned himself as best he could but as the night went on he started to develop stomach pains and a sever case of diarrhea. This morning he was feeling better but was concerned of the symptoms that he had experienced;States he did have diarrhea and this has since resolved. I spilled this on my forearms and hands. I washed myself afterwards with just a little bit of water. Then when I got home I cleaned my self with soap and water. The diarrhea started 6-7 hours following exposure, and they resolved mostly today. I was also using "BENZED"(repeatedly asked caller to spell this, spelling would change with each response, unable to locate any product by this name). This was work related. I did not seek medical care, I stayed home and managed it myself. Sx.