Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-1441
2. Registrant Information.
Registrant Reference Number: 80084442
Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.
Address: Suite 2100, 450 - 1st Street S.W.
City: Calgary
Prov / State: Alberta
Country: Canada
Postal Code: T2P 5H1
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
14-AUG-08
5. Location of incident.
Country: CANADA
Prov / State: ALBERTA
6. Date incident was first observed.
30-JUL-08
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. 20944
PMRA Submission No.
EPA Registration No.
Product Name: Lorsban 50W Wettable Powder Insecticide
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: Agricultural-Outdoor/Agricole-extérieur
Préciser le type: fields around airstrip
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Some of the airstrip is fenced - unknown if all is fenced. The airstrip has a fair amount of land around it but then is surrounded by agricultural fields. The agricultural fields around the airstrip were treated with two chemicals (Decis 5 EC Insecticide and Lorsban 50W wettable powder Insecticide), but it was a couple of weeks ago.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
Rottweiler
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
10
7. Weight (provide a range if necessary )
43
kg
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Salivating excessively
- Symptom - Vomiting
- Symptom - Other
- Specify - increased swallowing - moderate
- Symptom - Mouth Irritation
- Specify - Small erosion on inside of left cheek - mild
- Symptom - Other
- Specify - Tense abdomen - moderate
- General
- Symptom - Grass ingestion
- Specify - Grass ingestion - mild
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
No
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
16. How was the animal exposed?
Other / Autre
specify Unknown
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Fluids were started and the swallowing seemed improved.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
History is vague. Sometime on July 30/08, the owner was at a small airstrip with the dog. At the airstrip, the dog "ran off". It is unknown for how long or how far the dog could have ran. It is unknown how long after the dog ran off that clinical signs started. The owner called the town who told him the land had been "treated" in the past couple of days and gave the owner numbers of companies who treat in the area. The owner and clinic called these companies but they were not being forth coming with information. The only thing that was learned was that some of the agricultural fields around the airstrip were treated with chemicals, but it was a couple of weeks ago. Because the time course was unknown consistent, the amount was unknown consistent, and the findings were poorly consistent, this substance was considered to have low likelihood of causing the clinical situation.