Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-4587

2. Registrant Information.

Registrant Reference Number: 3923166

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

Packaging Failure

4. Date registrant was first informed of the incident.

29-MAY-24

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

29-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)

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PMRA Registration No. 24299      PMRA Submission No.       EPA Registration No.

Product Name: ROUNDUP READY-TO-USE GRASS & WEED CONTROL WITH FASTACT FOAM

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

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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: 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.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Edema

• Nervous and Muscular Systems
  • Symptom - Numbness

• Skin
  • Symptom - Tingling skin

4. How long did the symptoms last?

Unknown / Inconnu

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

No

6. a) Was the person hospitalized?

No

6. b) For how long?

Unknown

7. Exposure scenario

Non-occupational

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

Application

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

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

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.)

5/29/2024 All of the following was spontaneously reported by the caller. Consumer reports experiencing tingling and numbness after using the RoundUp RTU Grass & Weed Control with FastAct Foam. Approximately 15 min prior to the call, she was spraying the product without gloves on. When she went to turn the nozzle, some of the solution leaked out onto her hands and arm. She immediately went inside and washed her skin several times with soap and hot water. Consumer reports that the sensation feels like ants on her skin and towards the end of the call, she reported having numbness on her arm. Consumer was very anxious to know whether the product could be absorbed into the bloodstream since it "kills trees".

To be determined by Registrant

14. Severity classification.

Minor

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 can not 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.

Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Bottle-plastic / Bouteille-plastique

2. Did packaging failure occur during?

Use of Product

3. Did packaging failure result in?

potential injury

potential exposure

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

5/29/2024 All of the following was spontaneously reported by the caller. Consumer reports experiencing tingling and numbness after using the RoundUp RTU Grass & Weed Control with FastAct Foam. Approximately 15 min prior to the call, she was spraying the product without gloves on. When she went to turn the nozzle, some of the solution leaked out onto her hands and arm. She immediately went inside and washed her skin several times with soap and hot water. Consumer reports that the sensation feels like ants on her skin and towards the end of the call, she reported having numbness on her arm. Consumer was very anxious to know whether the product could be absorbed into the bloodstream since it "kills trees".

For Registrant use only

5. 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 can not 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.