Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-3037

2. Registrant Information.

Registrant Reference Number: 2023-08

Registrant Name (Full Legal Name no abbreviations): BASF Canada Inc.

Address: 5025 Creekbank Road, Building A, 2nd Floor

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L4W 0B6

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

Human

4. Date registrant was first informed of the incident.

12-JUN-23

5. Location of incident.

Country: UNITED STATES

Prov / State: OKLAHOMA

6. Date incident was first observed.

05-JUN-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.       PMRA Submission No.       EPA Registration No. 499-561

Product Name: PRESCRIPTION TREATMENT BRAND ALPINE WSG

• Active Ingredient(s)
  • DINOTEFURAN
    • Guarantee/concentration 40 %

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

Product Name: PYRICIDE 100

• Active Ingredient(s)
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • Guarantee/concentration .4 %
  • PERMETHRIN
    • Guarantee/concentration .4 %
  • PYRETHRINS
    • Guarantee/concentration .05 %
  • PYRIPROXYFEN
    • Guarantee/concentration .1 %

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

Product Name: Advion- Gel Bait

• Active Ingredient(s)
  • INDOXACARB TECHNICAL

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7. b) Type of formulation.

Other (specify)

water soluble granule

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Pub. Area - Indoor/Zone publique - int

Préciser le type: Restaurant

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

Caller stated her place of employment, a restaurant, was sprayed with the product on 6/5/2023 in between the hours of 1:30am and 7am. The applicator, [Company], was contacted and stated the other products applied were Pyricide 100 and Advion- Gel Bait.

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: Female

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

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Asthma
  • Symptom - Laboured breathing

• Nervous and Muscular Systems
  • Symptom - Headache

• Gastrointestinal System
  • Symptom - Stomach pain

• Respiratory System
  • Symptom - Difficulty Breathing

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

Non-occupational

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

Other

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.

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.)

The subject and her colleague entered their place of work (a restaurant) at 7:10 am on June 5, 2023. The subject immediately got a headache, had an asthma attack, trouble breathing and stomach pains. She believes she may have inhaled fumes of the products applied. Her colleague reported having a headache and feeling tired. An ambulance was called to the workplace. The subject was treated with oxygen and had her vitals checked. The subject was not transported to the hospital at this point. On June 9, the subject went to urgent care where she was prescribed Methylprednisolone. The subject on June 10 said their headache and stomach pains were on and off but not as bad as they were on June 5. The subject also took Excedrin Extra Strength and an unspecified sinus allergy medication since onset of symptoms. The subject said it is hard to breathe when outdoors but thinks it is the air quality due to the fires they are having in the state.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

The information contained in this report is based on self-reported statements provided to the registrant during telephone interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and cannot form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews. The information contained in this report does not admit any association between the pesticide and the reported effect(s).