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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-2182

2. Registrant Information.

Registrant Reference Number: DASC140502-00

Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.

Address: Suite 2100, 450-1st Street S.W.

City: Alberta

Prov / State: Calgary

Country: Canada

Postal Code: T2P 5H1

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

Human

Domestic Animal

Environment

4. Date registrant was first informed of the incident.

12-MAY-14

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

02-MAY-14

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. 28945      PMRA Submission No.       EPA Registration No.

Product Name: Garlon XRT

  • Active Ingredient(s)
    • TRICLOPYR

PMRA Registration No. 29994      PMRA Submission No.       EPA Registration No.

Product Name: Vantage XRT

  • Active Ingredient(s)
    • GLYPHOSATE (PRESENT AS DIMETHYLAMINE SALT)

PMRA Registration No. 23713      PMRA Submission No.       EPA Registration No.

Product Name: Arsenal

  • Active Ingredient(s)
    • IMAZAPYR

PMRA Registration No. 29232      PMRA Submission No.       EPA Registration No.

Product Name: Payload

  • Active Ingredient(s)
    • FLUMIOXAZIN

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

4

Units: L/ha

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

Site: Industrial / Industriel

Préciser le type: Right-of-way

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

A licensed applicator sprayed a rail balast with Payload, Vantage XRT and Arsenal, and then sprayed the railway bed with Garlon XRT, On-Site and Halt when the alleged drift occured onto 6 blueberry farms.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

  • Skin
    • Symptom - Rash
  • Respiratory System
    • Symptom -
    • Specify - Throat constricted

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)

Drift from the application site

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.

Skin

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.)

Caller stated she had a rash all over her hands and that she felt that her throat was constricted.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Bird - Poultry / Oiseau - Volaille

3. Breed

Chickens

4. Number of animals affected

0

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Respiratory

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • General
    • Symptom - Death

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

Died

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

Caller stated that 5% of their chickens in both chicken barns died two days after the alleged spray drift.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Trees or shrubs / Arbre ou arbuste

2. Common name(s)

blueberries

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Terrestrial

Other

Salt Water

6. Check all symptoms that apply

Abnormal leaf discoloration

7. Describe symptoms and outcome (died, recovered, etc.).

Drift occurred onto 6 blueberry farms. One farm looked to be more affected as it had more browning leave spots. For a few of the farms, it was more difficult to find the spots on the blueberry leaves. Blueberry bushes in all 6 farms were showing some new growth.

8. a) Was the incident a result of (select all that apply)

Drift

N/A

8. b) i) How many times has the product been applied this year?

8. b) ii) What was the date of the last application?

9. Did it rain

9. a) During application?

No

9. b) Up to 3 days after application?

No

10. a) Was there a buffer zone?

No

10. b) What type?

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

No

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

Minor

13. Please provide supplemental information here