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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7234

2. Registrant Information.

Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.

Address: Suite 2100, 450 - 1st Street SW

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2P 5H1

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

Domestic Animal

4. Date registrant was first informed of the incident.

15-AUG-07

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

13-AUG-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. 14879      PMRA Submission No.       EPA Registration No.

Product Name: Lorsban 4E

  • Active Ingredient(s)
    • CHLORPYRIFOS

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 III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

German Shepard

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

12.5

7. Weight (provide a range if necessary )

100

lbs

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

  • Respiratory System
    • Symptom - Panting
  • General
    • Symptom - Death

12. How long did the symptoms last?

>30 min <=2 hrs / >30 min <=2 h

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

Died

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

German Shepherd Dog named Ziggy (Canine Domestic) Signalment 12.5 yr neutered male weighing 100.0 lb. Was in good health previously. Agent Exposure Lorsban 4E Insecticide (Canadian Product) (evidence agent id) Possible exposure occurred on Aug 13, 2007 at 09:30 AM CDT (evidence ). Exposure involved unknown amount dermally and orally. The exposure was accidental, and occurred at animal owner yard. [Note : Owner spilt some of the diluted product onto some gravel and there is a chance the dog may have walked through the diluted product before it dissipated down below the surface area. Two hours following the spill, the owner noticed "Ziggy" panting, but didn't think much about it since the dog was still fairly active for its 12.5 years (and owner simply assumed the dog had been running around). A short time later the dog was laying down in the shed with the owner; when the owner looked over, he noticed that "Ziggy" had died. "Ziggy" had been taking medication for an irregular heart beat for the past 2-3 months, according to the owner. (by (name) on Aug 15, 2007 at 10:21 AM)] Because the amount was poorly consistent, the patient was considered to be at low risk of developing clinical signs. If signs develop, there is low risk that those signs will be life-threatening. [Note : With dermal and/or oral exposure to the diluted product, "Ziggy" could develop mild, self-limiting GI upset (hypersalivation, vomiting and diarrhea). In exposures to the concentrated form (which did not occur in this case) the develoment of CNS signs could additionally occur. (by (name) on Aug 15, 2007 at 10:21 AM)] Clinical Status Panting {Respiratory} Time Observed: Aug 13, 2007 at 11:30 AM CDT Status: Mild Death {General Disorders} Permanent: Aug 13, 2007 at 12:00 PM CDT Status: Death Potential Causes Lorsban 4E Insecticide (Canadian Product) Because the time course was not consistent, the amount was poorly consistent, and the findings were not consistent, this substance was considered to have not related likelihood of causing the clinical situation. [Note : Signs are not consistent with exposure to the product. Suspect the dog died of heart failure. (by (name) on Aug 15, 2007 at 10:21 AM)] Acute Congestive Heart Failure Because the time course was unknown consistent and the findings were generally consistent, this condition was considered to have high likelihood of causing the clinical situation. Patient Care Planned/Recommended Care No Treatment Necessary Purpose: Other; Importance: Not indicated Who: Not asked ; Willingness: Not asked Recommended Outcome Died , EPA max illness designation: D-A [Note : Taking enacard (low dose) for irregular heartbeat -- for 2-3 months. (by (name) on Aug 15, 2007 at 10:21 AM)]


To be determined by Registrant

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

Death

19. Provide supplemental information here