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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-1603

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

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

Domestic Animal

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

02-AUG-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. 23705      PMRA Submission No.       EPA Registration No.

Product Name: PYRINEX 480EC FOR FOOD CROPS

  • Active Ingredient(s)
    • CHLORPYRIFOS

PMRA Registration No. 30332      PMRA Submission No.       EPA Registration No.

Product Name: VERTISAN FUNGICIDE

  • Active Ingredient(s)
    • PENTHIOPYRAD

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: Sunflower field

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

Both products above were tank mixed and applied via Aerial application. Product was applied to a sunflower field during bloom. Restriction on the label of Pyrinex indicates it should not be applied during bloom. The pond was sprayed via aerial application. Water was tested and showed to have levels of 0.0046ml/litre (4.6ppb) chlorpyrifos. Sample taken three days after spraying (August 5, 2014). Application was drift off field and occured one time.

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

Animal's Owner

2. Type of animal affected

Fish / Poisson

3. Breed

Rainbow Trout

4. Number of animals affected

100

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Eye

Oral

Respiratory

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Death
    • Symptom - Lethargy

12. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

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

Initially found the first few fish floating dead and noticed some swimming lethargically around the shore. As the week progressed more and more fish were found dead. Some of the fish seemed to be diving down under weeds and grasses and seemed to be trying to get away from affected water. Found dead fish along shore and along bottom of the pond. All fish in pond died within a week. Along with fish, also found dead birds, dragonflies, frogs and many other insects in and around the pond.Concern about bees and other insects around the field. There are three yards located close to the sunflower field that was sprayed during blooming. Bees would have been in the field so is concerned with their exposure and potential drift onto the bee yards.


To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here