Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4336

2. Registrant Information.

Registrant Reference Number: 2007-1

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

Address: 100 Milverton Drive, 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.

05-MAY-07

5. Location of incident.

Country: UNITED STATES

Prov / State: TENNESSEE

6. Date incident was first observed.

23-APR-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: Amdro Pro Granular Fire Bait

• Active Ingredient(s)
  • HYDRAMETHYLNON
  • Other Units - Unknown

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7. b) Type of formulation.

Bait

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: owner field/pasture

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

ASPCA report 70043680:Applied Amdro Pro Granular Fire Bait 2 weeks before on fire ant mounds in field in Dayton,TN USA. Observed exposure occurred on April23, 2007 12PM CDT. Unknown amount orally.

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

Cow / Vache

3. Breed

calf

4. Number of animals affected

2

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

9. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Death

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

Not recovered / Non 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

Observed exposure on April 23, 2007 at 12PM CDT. Exposure involved unknown amount orally. The exposure was accidental and occurred at animal owner field. "Used Amdro 2 weeks ago on a few ant mounts in the field. This morning found 2 dead calves."

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To be determined by Registrant

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

Death

19. Provide supplemental information here

Incident is for a USA bait formulation (Amdro Pro Granular Fire Ant Bait) used to treat fire ant mounds. Based on the known toxicology of Hydramethylnon (including on cows), and the wide margin of safety, the product is unlikely to have caused the clinical outcome.