Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3679

2. Registrant Information.

Registrant Reference Number: 09080901

Registrant Name (Full Legal Name no abbreviations): Nufarm Agriculture Inc

Address: 5507 1st St SE

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2H 1H9

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

28-AUG-09

5. Location of incident.

Country: UNITED STATES

Prov / State: ALASKA

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. 71368-11

Product Name: Weedone LV6 EC Broadleaf Herbicide

• Active Ingredient(s)
  • 2,4-D (PRESENT AS LOW VOLATILE ESTERS)
    • Guarantee/concentration 57.5 %

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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).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: pasture

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

Product was applied two weeks ago to pasture according to labeled directions.

To be determined by Registrant

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

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Horse / Cheval

3. Breed

American Quarter Horse

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

1100

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>1 wk <=1 mo / > 1 sem < = 1 mois

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Diarrhea

• Renal System
  • Symptom - Creatinine increased
  • Specify - Elevated kidney function tests (BUN, SCr)

• Blood
  • Symptom - Blood urea nitrogen increased
  • Specify - Elevated kidney function tests (BUN, SCr)

12. How long did the symptoms last?

Unknown / Inconnu

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

Yes

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

The vet was informed that the reported symptoms are neither typical or expected under routine circumstances of use, and is not likely related. MSDS was faxed after first call (August 28, 2009). Initially the horse presented persistent watery diarrhea and elevated kidney function tests. On August 30, 2009 the horse died. The on-site necropsy showed a normal GI tract and pus in one kidney; culture was sent to lab for histopathology and toxicology testing. Pooled culture showed Clostridium perfringens, intestinal E coli and Enterococcus. Histopathology was pretty normal, but rare oxalate crystals in kidney were found. No diagnostic was provided.

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To be determined by Registrant

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

Moderate

19. Provide supplemental information here

Symptoms are neither typical or expected after exposure to 2,4-D.