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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-1441

2. Registrant Information.

Registrant Reference Number: 80084442

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.

Domestic Animal

4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.


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.


PMRA Registration No. 20944      PMRA Submission No.       EPA Registration No.

Product Name: Lorsban 50W Wettable Powder Insecticide

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: fields around airstrip

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

Some of the airstrip is fenced - unknown if all is fenced. The airstrip has a fair amount of land around it but then is surrounded by agricultural fields. The agricultural fields around the airstrip were treated with two chemicals (Decis 5 EC Insecticide and Lorsban 50W wettable powder Insecticide), but it was a couple of weeks ago.

To be determined by Registrant

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


Subform III: Domestic Animal Incident Report

1. Source of Report


2. Type of animal affected

Dog / Chien

3. Breed


4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Salivating excessively
    • Symptom - Vomiting
    • Symptom - Other
    • Specify - increased swallowing - moderate
    • Symptom - Mouth Irritation
    • Specify - Small erosion on inside of left cheek - mild
    • Symptom - Other
    • Specify - Tense abdomen - moderate
  • General
    • Symptom - Grass ingestion
    • Specify - Grass ingestion - mild

12. How long did the symptoms last?

Unknown / Inconnu

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


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


16. How was the animal exposed?

Other / Autre

specify Unknown

17. Provide any additional details about the incident

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

Fluids were started and the swallowing seemed improved.

To be determined by Registrant

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


19. Provide supplemental information here

History is vague. Sometime on July 30/08, the owner was at a small airstrip with the dog. At the airstrip, the dog "ran off". It is unknown for how long or how far the dog could have ran. It is unknown how long after the dog ran off that clinical signs started. The owner called the town who told him the land had been "treated" in the past couple of days and gave the owner numbers of companies who treat in the area. The owner and clinic called these companies but they were not being forth coming with information. The only thing that was learned was that some of the agricultural fields around the airstrip were treated with chemicals, but it was a couple of weeks ago. Because the time course was unknown consistent, the amount was unknown consistent, and the findings were poorly consistent, this substance was considered to have low likelihood of causing the clinical situation.