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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4359

2. Registrant Information.

Registrant Reference Number: 2007-10

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

Address: 100 Milverton, 5th Floor

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5R4H1

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

12-JUN-07

5. Location of incident.

Country: CANADA

Prov / State: UNKNOWN

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)

PMRA Registration No. 27856      PMRA Submission No.       EPA Registration No.

Product Name: Dyvel DSP

  • Active Ingredient(s)
    • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
    • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
    • MECOPROP-P (PRESENT AS DIMETHYLAMINE SALT)

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: 1 acre?

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

Caller wanted info on Dyvel DSP. Someone sprayed 1 acre near her home this AM. Caller also had crew working on her home all day today outside. Area was sprayed at 0645 to 0800 and crew was there from start. Caller told PCC little wind today, crew working on her home is uphill from area that was sprayed.Area spayed is S & W from her home. Symptoms: crew working on her home are feeling: lightheaded,dizzy, not functioning well-not at 100%, nauseated. Had no eye irritation. Caller does not have sx but she was indoors most of day. Monday June 4, f/u call to home from PCC, workers re-scheduled to resume work as planned June 4, all workers are fine and back to work as planned. Unsure if medically evaluated. PCC medical outcome: Unrelated effect, the exposure was probably not responsible for the effect(s).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

  • Nervous and Muscular Systems
    • Symptom - Dizziness
  • Gastrointestinal System
    • Symptom - Nausea

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Unrelated effect,the exposure was probably not responsible for the effect(s)