Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2024-0136
2. Registrant Information.
Registrant Reference Number: 2024-05
Registrant Name (Full Legal Name no abbreviations): BASF Canada Inc.
Address: 5025 Creekbank Road, Building A, 2nd Floor
City: Mississauga
Prov / State: Ontario
Country: Canada
Postal Code: L4W 0B6
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
19-DEC-23
5. Location of incident.
Country: UNITED STATES
Prov / State: NORTH CAROLINA
6. Date incident was first observed.
Unknown
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. 34816
PMRA Submission No.
EPA Registration No. 499-561
Product Name: Alpine WSG Water Soluble Granule Insecticide
- Active Ingredient(s)
- DINOTEFURAN
- Guarantee/concentration 40 %
7. b) Type of formulation.
Other (specify)
Water Soluble Granule
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
Site: Res. - In Home / Rés. - à l'int. maison
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
A pest control operator sprayed the baseboards in a home on December 15, 2023. The owner of the home had dogs and was directed to keep the dogs away from the area. The owner informed the pest control operator that a dog in the home passed away.
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
Other
2. Type of animal affected
Dog / Chien
3. Breed
Unknown
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
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.
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?
Other / Autre
specify Potential exposure from application to baseboards in home
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here