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
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.