Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-2329

2. Registrant Information.

Registrant Reference Number: X

Registrant Name (Full Legal Name no abbreviations): X

Address: X

City: X

Prov / State: X

Country: X

Postal Code: X

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

Human

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

23-MAY-24

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)

---

PMRA Registration No. 24977      PMRA Submission No.       EPA Registration No.

Product Name: FORAY 48B BIOLOGICAL INSECTICIDE AQUEOUS SUSPENSION

• Active Ingredient(s)
  • BACILLUS THURINGIENSIS SUBSPECIES KURSTAKI (ALL STRAINS)

---

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Pub. Area - Outdoor/Zone publique - ext

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

I was aware of the first aerial spray of the Foray48B (for spongy moth control) that took place earlier this month on our island. I didn't know the date of the second spray (May 23) and on that day I went to do yard work at my friend's property who is exactly in the area where they sprayed in the morning. I went to work there around 10.30 and was there until 4pm. I couldn't understand what my symptoms were related to and it's only a few days later that I found out about the spray that occurred on that day.

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

• Nervous and Muscular Systems
  • Symptom - Headache

• General
  • Symptom - Other
  • Specify - Feeling off

• Skin
  • Symptom - Flushed
  • Specify - Hot flashes

• General
  • Symptom - Lightheadedness

• Gastrointestinal System
  • Symptom - Nausea

• General
  • Symptom - Weakness

• Skin
  • Symptom - Other
  • Specify - Face turned green-yellow

• Gastrointestinal System
  • Symptom - Anorexia
  • Symptom - Other
  • Specify - Burping

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?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

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)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

Started with a headache at night after being exposed ; woke up next morning feeling 'off', still with a headache. A couple hours later the headache got stronger and I started having something that looked like a vasovagal episode, hot flashes, felt like I was going to faint, felt nauseous, felt really weak. My husband who was with me said my face turned green-yellow. Any movement was making me feel more nauseous and headachy. I couldn't eat, any smell was also making me feel more nauseous. We were out at an appointment when the symptoms got stronger. My husband had to drive me home, I had to cancel my work day. I went to bed around 2.30 in the afternoon and stayed in bed til the next day around noon. Throughout that time, I kept feeling like I was going to throw up and burping was giving me a little relief. On that next day, my headache was gone, I still felt weak but I was able to resume my activities later in the day.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.