Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2968

2. Registrant Information.

Registrant Reference Number: 336469

Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.

Address: 450-1st Street S.W., Suite 2100

City: Calgary

Prov / State: AB

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.

23-JUN-08

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

19-JUN-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. 24834      PMRA Submission No.       EPA Registration No.

Product Name: Attain A Herbicide

• Active Ingredient(s)
  • FLUROXYPYR 1-METHYLHEPTYL ESTER

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PMRA Registration No. 24833      PMRA Submission No.       EPA Registration No.

Product Name: Attain B Herbicide

• Active Ingredient(s)
  • 2,4-D (PRESENT AS LOW VOLATILE ESTERS)

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

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

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 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

• Nervous and Muscular Systems
  • Symptom - Headache

• Respiratory System
  • Symptom - Respiratory congestion
  • Symptom - Shortness of breath

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

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)

Unknown

10. Route(s) of exposure.

Skin

Oral

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 h

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.)

6/23/08 Caller is the friend of the exposed person. Patient was putting product into a sprayer four days ago, and spilled product onto torso and face and may have swallowed a small amount. Patient immediately removed clothing and washed in the field with soap and water, and showered later in the day. Patient developed a headache, congestion, and difficulty breathing two hours later and left work for home. The symptoms persisted, and the patient was evaluated by a doctor two days later. Doctor gave Demerol for the headache and discharged the patient after a few hours. 6/24/08 Caller is nurse practitioner evaluating the patient. Patient has visible irritation in the nose and complains of throat irritation. An x-ray shows lung congestion. Patient has a headache and right eye pain. Fluorescein stain of the eye shows small areas of uptake which seem to be healing. Nurse practitioner is planning to start nebulizer therapy, steroids, antibiotic eye drops, saline nasal spray, and refer to ophthalmologist. 6/30/08 CB attempted to original caller. A message was left requesting follow up information. 7/1/08 CB attempted to original caller. A message was left requesting follow up information. Original caller returned previous message. Caller has no additional information about the patient.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews. Given that exposure to face and eyes to these herbicide components, localized irritating effects are possible.