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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-5492

2. Registrant Information.

Registrant Reference Number: ASPCA 80098638

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

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

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2P 5H1

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

Domestic Animal

4. Date registrant was first informed of the incident.

14-OCT-08

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

03-SEP-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. 9853      PMRA Submission No.       EPA Registration No.

Product Name: MCPA Amine 500 Liquid Farm Weed Killer

  • Active Ingredient(s)
    • MCPA (PRESENT AS AMINE SALTS: DIETHANOLAMINE, DIMETHYLAMINE, OR MIXED AMINES)

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

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

The exposure was accidental and occurred at the animal owner yard. The caller mixed agents 1 and 2 together (Roundup Herbicide and MCPA Amine 500 Liquid Farm Weed Killer) and sprayed some weeds. The dilution was maybe a little stronger than what was indicated on the label, but the owner didn't give specific dilution amount. He suspects the dog could have walked through the treated area and gotten exposed dermally and possibly orally from licking her paws.

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

Dog / Chien

3. Breed

Bullmastiff Dog

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

80

lbs

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

  • Nervous and Muscular Systems
    • Symptom - Seizure
    • Symptom - Disorientation
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Died

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

Received a message in the follow up voice mail box from an unidentified woman. Message was brief and stated that the dog had died over the weekend. They did not think that she was poisoned, but that she died from the seizures that she was having.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Toxicological Assessment: Because the time course was somewhat consistent, the amount was unknown and the findings were not consistent, this substance was considered to have doubtful likelihood of causing the clinical situation.