Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-8110
2. Registrant Information.
Registrant Name (Full Legal Name no abbreviations): Cheminova Canada Inc.
Address: 2660 Sherwood Heights Dr., Unit 201
City: Oakville
Prov / State: Ontario
Country: Canada
Postal Code: L6J 7Y8
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
23-AUG-07
5. Location of incident.
Country: UNITED STATES
Prov / State: OHIO
6. Date incident was first observed.
22-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.
PMRA Submission No.
EPA Registration No.
Product Name: Ace Ready to Use Weed and Grass Killer 2
- Active Ingredient(s)
- GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
- Guarantee/concentration 1.92 %
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
No
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
Site: Res. - Out Home / Rés - à l'ext.maison
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
Cat / Chat
3. Breed
Domestic shorthair cat
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
11
7. Weight (provide a range if necessary )
9.5
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- General
- Symptom - Vocalizing
- Symptom - Death
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
Unknown
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
Possible exposure occurred when pet owner's brother spilled product in garage and the cat licked up water off of the floor that was used to clean product. According to the veterinarian technician, the spilled product was cleaned up at least 24 hours before vomiting began. The owner did not observe the cat ingest the product.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
The amount of product ingested was unknown, the time it may have been ingested was not consistent, and the symptoms not consistent with glyphosate exposure. GI signs usually begin within a couple of hours of exposure. In follow-up, the veterinarian technician indicated that the cat had been blocked for a couple of days, and the cat died shortly after being unblocked.