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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-2101
2. Registrant Information.
Registrant Reference Number: 2009-IR-02
Registrant Name (Full Legal Name no abbreviations): E. I. du Pont Canada Company
Address: P.O. box 2300, Streetsville
City: Mississauga
Prov / State: ON
Country: Canada
Postal Code: L5M 2J4
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
22-JUN-095. Location of incident.
Country: UNITED STATES
Prov / State: MONTANA
6. Date incident was first observed.
09-JUN-09Product 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.
Product Name: Affinity Tank Mix Herbicide
- Active Ingredient(s)
- TRIBENURON METHYL
- Guarantee/concentration 50
- TRIBENURON METHYL
7. b) Type of formulation.
Other (specify)
Aersol Mist VaporApplication 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: pasture - grazing
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?
YesSubform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cow / Vache
3. Breed
cattle
4. Number of animals affected
2
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
>1 wk <=1 mo / > 1 sem < = 1 mois
10. Time between exposure and onset of symptoms
>3 days <=1 wk / >3 jours <=1 sem
11. List all symptoms
System
- General
- Symptom - Death
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
No
14. a) Was the animal hospitalized?
No
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
Farmer used Affinity with Roundup, had 40 heifers in area and they have been grazing off/on since spraying. Few days later he found a couple of heifers had died. Confirmed that product was applied per directions. Cattle had not been grazing in area for over a week and would have been okay in the field, however, the cattle that had dies had been in the field of Clover. It was determined that the cattle died from blotting from eating the clover. Only the cattle in the clover area were effected. Cattle owner was verifying he was doing the correct things and suspected it was the clover. Death unrelated to herbicide.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
