Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2141

2. Registrant Information.

Registrant Reference Number: SC477945

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

Address: 450-1st Street SW, Suite 2100

City: Calgary

Prov / State: AB

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.

27-MAY-09

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

Unknown

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.

Product Name: Lorsban (non-specific)

• Active Ingredient(s)
  • CHLORPYRIFOS
    • Unknown

---

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

Product Name: Dormant oil

• Active Ingredient(s)

---

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

Product Name: Rubigon

• Active Ingredient(s)

---

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

Product Name: Polyram

• Active Ingredient(s)

---

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

Product Name: Imidan

• Active Ingredient(s)
  • PHOSMET
    • Unknown

---

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

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

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

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

No

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Cardiovascular System
  • Symptom - Arrhythmia

• Eye
  • Symptom - Other
  • Specify - Spots in visual field

• General
  • Symptom - Malaise

• Nervous and Muscular Systems
  • Symptom - Ataxia
  • Symptom - Other
  • Specify - Nightmares

• Respiratory System
  • Symptom - Decreased pulmonary function
  • Specify - lung function impairment
  • Symptom - Respiratory irritation

• Skin
  • Symptom - Tingling skin

• Nervous and Muscular Systems
  • Symptom - Other
  • Specify - Chronic neurological dysfunction

4. How long did the symptoms last?

>6 mos / > 6 mois

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Application

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Skin

Respiratory

11. What was the length of exposure?

>1 mo <= 6 mos / > 1 mois < = 6 mois

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.)

5/27/2009 Caller reports working for a company periodically from 1996 to 1998 during which time caller used a handmade spraying device containing a mixture of the products at an unknown dilution rate. Caller would mix the products using a coffee cup, and did not wear gloves or a respirator during application. Caller had product splash onto both hands hands and would breath product during application, and never would decontaminate after application. Some time after this, caller could not be specific, caller developed flu-like symptoms. Six months later caller developed tingling in both hands, burning in the lungs, unsteady gate, nightmares, irregular heart beat, and spots in the visual field. Caller has seen multiple doctors, and was diagnosed with chronic organophosphate neurological dysfunction as well as lung function impairment. Caller states that acetylcholinesterase was tested in 1999, and caller believes the results were high. Caller is currently taking psychiatric medication and performing physical therapy for treatment for his continued disability.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews. When considering the body of regulatory data as well as the weight of scientific peer reviewed data, a causal relationship between the individual ingredients used in the various products implicated in this case and the insidious/delayed medical complications reported by this patient lacks any biological plausibility. Furthermore, a report of elevated cholinesterase activity in 1999 would suggest that significant exposure to a cholinesterase inhibitor like Lorsban has been ruled out, at least as far as acute exposure is concerned.