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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-4449
2. Registrant Information.
Registrant Reference Number: SR# 1-129254829
Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.
Address: Suite 2100, 450 - 1st Street S.W.
City: Calgary
Prov / State: Alberta
Country: Canada
Postal Code: T2P 5H1
3. Select the appropriate subform(s) for the incident.
Packaging Failure
4. Date registrant was first informed of the incident.
25-MAY-075. Location of incident.
Country: CANADA
Prov / State: QUEBEC
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. 24707 PMRA Submission No. EPA Registration No.
Product Name: Kelthane* 50W Agricultural Miticide
- Active Ingredient(s)
- DICOFOL
7. b) Type of formulation.
Application Information
8. Product was applied?
Unknown
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
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 VI: Packaging Failure
1. What is the type of packaging that failed?
Bag-plastic / Sac-plastique
2. Did packaging failure occur during?
Storage
3. Did packaging failure result in?
potential exposure
4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.
A customer who has received a case of Kelthane* 50W had a few broken bags or wrongly closed or sealed bags in the case. When opening the case, the employee from [COMPANY NAME], has been contaminated by the product. There is no report of poisoning beside the big inconvenient of having to clean the mess and a few words.
