Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2017-2939
2. Registrant Information.
Registrant Reference Number: 2017-7
Registrant Name (Full Legal Name no abbreviations): BASF
Address: 100 milverton
City: Mississauaga
Prov / State: ON
Country: Canada
Postal Code: l5R4H1
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
13-MAY-17
5. Location of incident.
Country: CANADA
Prov / State: ALBERTA
6. Date incident was first observed.
11-MAY-17
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. 30685
PMRA Submission No.
EPA Registration No.
Product Name: INSURE CEREAL
- Active Ingredient(s)
- METALAXYL
- PYRACLOSTROBIN
- TRITICONAZOLE
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: Other / Autre
Préciser le type: seed
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
grain was treated for planting
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
Dog / Chien
3. Breed
cane corso
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
2.5
7. Weight (provide a range if necessary )
74
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
>24 hrs <=3 days / >24 h <=3 jours
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Vomiting
- Symptom - Anorexia
12. How long did the symptoms last?
Unknown / Inconnu
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
Unknown/Inconnu
16. How was the animal exposed?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Dog had access and was eating treated grain from 5/11 to 5/13 when symptoms noticed
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here
medium likelihood