Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2013-2562
2. Registrant Information.
Registrant Reference Number: 201
Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.
Address: Suite 2100, 450 - 1 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.
08-AUG-12
5. Location of incident.
Country: CANADA
Prov / State: SASKATCHEWAN
6. Date incident was first observed.
08-AUG-12
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. 14879
PMRA Submission No.
EPA Registration No.
Product Name: Lorsban 4E 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: pasture
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Exposure involved unknown amount dermally. The exposure was accidental, and occurred at animal owner field/pasture. Yesterday morning, the owner was feeding his livestock and saw the plane approach and spray the neighboring pasture. Some of the spray misted horses and cattle.
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
Medical Professional
2. Type of animal affected
Cow / Vache
3. Breed
Simmental (bovine)
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
2
7. Weight (provide a range if necessary )
1500
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Stiffness
- Specify - Stiffness in the front end of one of the bulls
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
16. How was the animal exposed?
Spray drift / Dérive de pulvérisation
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Exposure involved unknown amount dermally. The exposure was accidental, and occurred at animal owner field/pasture. Yesterday morning, the owner was feeding his livestock and saw the plane approach and spray the neighboring pasture. Some of the spray misted his horses and cattle. They are asymptomatic.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here