Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2240

2. Registrant Information.

Registrant Reference Number: SN-19671-080530

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.

Human

4. Date registrant was first informed of the incident.

30-MAY-08

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

18-MAY-08

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)

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PMRA Registration No. 27395      PMRA Submission No.       EPA Registration No.

Product Name: Prepass A (a component of Prepass Herbicide Tank Mix)

• Active Ingredient(s)
  • FLORASULAM

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Pasture

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Grower was using Prepass over a period of 2 days. He was using a tractor pulled field sprayer, equipped with a chem handler. He commented he is aware of wind and loads his sprayer upwind. PPE used: he used rubber gloves and coveralls, he wears glasses (not goggles).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Malaise
  • Specify - Felt crappy

• Nervous and Muscular Systems
  • Symptom - Aching
  • Specify - sore back-similar to a kidney infection
  • Symptom - Headache

• Gastrointestinal System
  • Symptom - Nausea

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Application

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Chemical resistant gloves

Chemical resistant coveralls

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

Date of exposure: grower could not remember, he thought the call was on a Sunday afternoon. He says he talked to someone in the US, he thought it was a pharmacist (?). Grower did not seek medical attention. He commented that he has experienced similar symptoms in the past when he was spraying herbicides. Grower has been farming and using pesticide products for over 40 years (his farm is currently for sale and he is retiring).

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.