Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3158

2. Registrant Information.

Registrant Reference Number: SC496814

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.

03-JUL-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 62719-32

Product Name: Curfew Soil Fumigant

• Active Ingredient(s)
  • 1,3-DICHLOROPROPENE
    • Guarantee/concentration 97.5 %

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7. b) Type of formulation.

Other (specify)

Fumigant

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Pub. Area - Outdoor/Zone publique - ext

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?

Yes

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: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Shortness of breath
  • Symptom - Other
  • Specify - Oropharyngeal edema

• Gastrointestinal System
  • Symptom - Tongue swelling
  • Symptom - Difficulty swallowing

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

3

Day(s) / Jour(s)

7. Exposure scenario

Non-occupational

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)

None

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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.)

7/3/2009 Caller reports that a family member lives adjacent to a golf course where the product was applied two days ago. Yesterday, the family member developed difficulty swallowing and drove to the hospital. The family member was found to have an evolving allergic reaction of unknown cause, which eventually required intubation due to swelling of the tongue and airway. The family member is currently sedated on a ventilator, and is receiving intravenous steroids and Benadryl. 7/6/2009 Attempted callback to original caller. A message was left requesting follow up information. 7/9/2009 Callback to original caller for follow up. The physicians determined that the allergic reaction was due to a new medication the family member was taking, and have ruled out any involvement of the product.

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. Description of events does not provide an indication of a defined point of exposure. The onset of this patient¿s illness was merely temporally related to the use of the Curfew on adjacent property. A comprehensive hospital evaluation has definitively ruled out any involvement of the Curfew Soil Fumigant as the patient was diagnosed with an allergic reaction to a drug he recently started.