Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-5563
2. Registrant Information.
Registrant Reference Number: Rocky Mountain Poison and Drug case 5683558
Registrant Name (Full Legal Name no abbreviations): LOVELAND Products Canada, Inc.
Address: 789 Donnybrook Drive
City: Dorchester
Prov / State: Ontario
Country: Canada
Postal Code: N0L1G5
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
11-SEP-16
5. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
09-SEP-16
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. 9382
PMRA Submission No.
EPA Registration No.
Product Name: LAGON 480 E
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: CHERRY
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Neighbor was spraying and it drifted to a sweet corn crop and goats are grazing on the sweet corn. Lagon R 480E [Dimethoate 44% (organophosphate) cyclohexanone 39% (ketones)]
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
Other / Autre
specify BOER GOAT
3. Breed
BOER GOAT
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
180
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>3 days <=1 wk / >3 jours <=1 sem
11. List all symptoms
System
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
No
14. a) Was the animal hospitalized?
No
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
Neighboring farmer sprayed Lagon on the evening of Sept 9, 2016. Caller immediately noticed odor of spray drift in area where his 130 goats were grazing. Dead flies were seen in area where goats were present. Goats were removed from that area for 2 days. On Sept 15, 2016 one female goat of a 130 goat herd died. Caller will inform us if any more animals show symptoms after exposure.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here