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
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
- 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