Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4331

2. Registrant Information.

Registrant Reference Number: 2007-7

Registrant Name (Full Legal Name no abbreviations): BASF Canada

Address: 100 Milverton Dr, 5th floor

City: Mississauga

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.

04-JUN-07

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

31-MAY-07

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)

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

Product Name: Distinct

• Active Ingredient(s)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
  • DIFLUFENZOPYR

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

Product Name: Ultim 75

• Active Ingredient(s)
  • NICOSULFURON
  • RIMSULFURON

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

Product Name: Prosurf

• Active Ingredient(s)

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

Product Name: fertilizer

• Active Ingredient(s)

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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: Unknown / Inconnu

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

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

American Pit Bull terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

53

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Head tilt
  • Specify - head tilt to left (mild & resolving)

• General
  • Symptom - Lethargy
  • Symptom - Weakness

• Gastrointestinal System
  • Symptom - Salivating excessively
  • Specify - drooling

• General
  • Symptom - Abnormal behaviour
  • Specify - circling

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Fully Recovered / Complètement rétabli

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

Farmer mixed 2 products and sprayed field,short time later dog was running through field. Following AM, lethargic,weak,head tilt to left, and circling to left and mild drooling. Treated by vet...recpmmended:bath decontamination using liquid dish soap, fluid diuresis and diagnostic evaluation.

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To be determined by Registrant

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

Minor

19. Provide supplemental information here

Distinct Herbicide: because the time course was somewhat consistent, the amount was unknown consistent, and the findings were somewhat consistent, this substance was considered to have doubtful likelihood of causing the clinical situation.