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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-0183

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-14963800

Registrant Name (Full Legal Name no abbreviations): Loveland Products, Inc.

Address: 7251 West 14th Street

City: Greeley

Prov / State: Colorado

Country: USA

Postal Code: 80634

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

Domestic Animal

4. Date registrant was first informed of the incident.

03-JUN-07

5. Location of incident.

Country: UNITED STATES

Prov / State: PENNSYLVANIA

6. Date incident was first observed.

29-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.       PMRA Submission No.       EPA Registration No. 34704-69

Product Name: Atrazine 4L Herbicide - EPA 34704-69

  • Active Ingredient(s)
    • ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
      • Guarantee/concentration 42.2 %

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Unknown / Inconnu

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

Horse / Cheval

3. Breed

Mixed Breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

1000

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Muscle weakness
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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?

Other / Autre

specify Unknown

17. Provide any additional details about the incident

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

Owner is investigating what possibly caused the death of two of his horses. Stated that few days ago (more than a week) he applied "Atrazine 4L?, and during the past couple days 2 of his horses developed muscle weakness, and died. Unknown cause of death. Animal owner is asking for information regarding the toxicity of Atrazine 4L. Also, he's asking for mechanism of toxicity and treatment. In case that his other animals get sick? Response: Most probably death was not related to Atrazine. Rule out other possibly causes of death. Explained about low toxicity when ingested in small amounts.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Horse / Cheval

3. Breed

Standardbred

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

1000

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Muscle weakness

12. How long did the symptoms last?

Persisted until death

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?

Other / Autre

specify Unknown

17. Provide any additional details about the incident

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

Owner is investigating what possibly caused the death of two of his horses. Stated that few days ago (more than a week) he applied "Atrazine 4L?, and during the past couple days 2 of his horses developed muscle weakness, and died. Unknown cause of death. Animal owner is asking for information regarding the toxicity of Atrazine 4L. Also, he's asking for mechanism of toxicity and treatment. In case that his other animals get sick? Response: Most probably death was not related to Atrazine. Rule out other possibly causes of death. Explained about low toxicity when ingested in small amounts.


To be determined by Registrant

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

Death

19. Provide supplemental information here