Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-3778

2. Registrant Information.

Registrant Reference Number: 3964071

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.

22-JUL-24

5. Location of incident.

Country: UNITED STATES

Prov / State: CONNECTICUT

6. Date incident was first observed.

Unknown

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. 71995-56

Product Name: ROUNDUP READY-TO-USE WEED & GRASS KILLER PLUS FASTACT SELECT

• Active Ingredient(s)
  • DIQUAT
    • Unknown
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
    • Unknown

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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: 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?

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: Female

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

3. List all symptoms, using the selections below.

System

• Blood
  • Symptom - Other
  • Specify - Blood cancer

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?

Unknown

6. b) For how long?

Unknown

7. Exposure scenario

Non-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

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.

Unknown

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.)

7/22/2024 All of the following has been spontaneously reported by the caller. Caller is the husband of the consumer calling to report blood cancer they believe is a result of exposure to the product. Caller stated a lawn care company sprayed the product around their property approximately 6-7 months ago in 01/2024 to 02/2024. It is unclear if the consumer hired the company. Caller did not have a lot of information on symptoms that occurred or when they occurred. He stated his wife went in for lab work in approximately 01/2024 and the chemical from the product was found in the consumers blood. Consumer was diagnosed with blood cancer and is currently receiving chemo. Caller states consumer is doing much better and her blood is no longer thick. Caller was unable to provide details of the care consumer is receiving or when she has received it. This is the only information that was obtained.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

Company correlation score: 1 (Unlikely Relationship). Further information would be necessary to complete a full analysis. It is unclear when the application of the product occurred in regards to detection of the product in the blood and/or diagnosis of the blood cancer. Testing for glyphosate/diquat in the blood is not a standard health test typically done in a doctor's office. It is also unclear if and how the person may have been exposed to the product. The Environmental Protection Agency (EPA) concluded that glyphosate is not likely to be carcinogenic to humans.