Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2362

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

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

Human

Domestic Animal

4. Date registrant was first informed of the incident.

04-JUN-08

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

28-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)

---

PMRA Registration No. 19810      PMRA Submission No.       EPA Registration No.

Product Name: Par III Commercial Liquid Turf Herbicide

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
  • MECOPROP (PRESENT AS DIMETHYLAMINE SALT)

---

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

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

Site: Res. - Out Home / Rés - à l'ext.maison

Préciser le type: Neighbour's lawn

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

Pesticide applied on our neighbour's lawn. Applied with hose on many areas of the lawn. Windy that day. Very strong chemical odour.

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.

Data Subject

2. Demographic information of data subject

Sex: Female

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

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Burning eye
  • Symptom - Tearing

• Gastrointestinal System
  • Symptom - Sore throat

• General
  • Symptom - Chemical taste in mouth

• Nervous and Muscular Systems
  • Symptom - Headache

• General
  • Symptom -
  • Specify - Swollen nodes in neck
  • Symptom - Pain
  • Specify - Auxillary nodes
  • Symptom - Fatigue

• Gastrointestinal System
  • Symptom - Nausea

4. How long did the symptoms last?

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

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Drift from the application site

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

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

I went outside in my yard while the pesticide was being sprayed. I was only out for approximately 5 minutes. The odour was extremely strong. The taste of chemical started almost immediately. As a family doctor and a mother of a (age) girl and a (age) boy I am appaled that these products are still used. Many studies demonstrate a clear link between 2,4-D and many ill effects. 2,4-D has been related to: 1 - Non-Hodgkin lymphoma, 2 - Brain tumours, 3 - childhood cancers, 4 - lymphomas in dogs, 5 - reproductive problems in women, just to name a few. We are literally poisoning ourselves. The government should have banned these substances many years ago. Thank you.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Labrador retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Lethargy

12. How long did the symptoms last?

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

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Spray drift / Dérive de pulvérisation

specify Dog was outside on our lawn while our neighbour's lawn was being sprayed.

17. Provide any additional details about the incident

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

It is clear that these pesticides are harmful. Our dog was basically poisoned (mildly of course as he didn't die). There is no place in our society for such strong & harmful products. It is quite sad to see that a green lawn is more important than our health.

---

To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here