Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-1443

2. Registrant Information.

Registrant Reference Number: 80093430-1

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.

Human

4. Date registrant was first informed of the incident.

18-AUG-08

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

18-AUG-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.       PMRA Submission No.       EPA Registration No. 464-404

Product Name: Lorsban F Insecticidal Chemical

• Active Ingredient(s)
  • CHLORPYRIFOS

---

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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: n/a

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

Field next to cows was sprayed with product. Possibly blown into their pasture.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Nausea
  • Symptom - Vomiting

• Nervous and Muscular Systems
  • Symptom - Dizziness

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

Field next to cows was sprayed with product on August 18/08. Possibly blown into their pasture. The owner and his son were located near the field when it was sprayed. For the next 24 hours, both owner and son were nauseous, vomiting and dizzy. It is unknown if the owner and son were treated. The DVM stated that he thinks they are feeling fine now.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.