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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-4385

2. Registrant Information.

Registrant Reference Number: Prosar 1-19725814

Registrant Name (Full Legal Name no abbreviations): FMC Corporation

Address: 1735 Market Street

City: Philadelphia

Prov / State: Pennsylvania

Country: USA

Postal Code: 19103

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

Domestic Animal

4. Date registrant was first informed of the incident.

10-AUG-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. 279-3351

Product Name: Dismiss South Turf+IVM (F7119)

  • Active Ingredient(s)
    • IMAZETHAPYR
      • Guarantee/concentration 6.67 %
    • SULFENTRAZONE

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: 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).

The product was applied to a golf course on an unknown date.

To be determined by Registrant

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

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Fish / Poisson

3. Breed

Unknown

4. Number of animals affected

10

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?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

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.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Unknown if exposure occurred. Possible wash off into pond.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-19725814: A reporter called on 08/10/2009 to report the possible exposure of fish to an herbicide containing the active ingredients Sulfentrazone and Imazethapyr. According to the reporter, the product was applied at an unknown rate on an unknown date to a golf course with 4 ponds. An unknown time following product application, there was fish kill (of fish 4 inches long or smaller) in 1 of the ponds. The fish in the other 3 ponds were unaffected. The reporter thought that the fish deaths may be unrelated to the product, since the other ponds were not affected at all. No further information was obtained.


To be determined by Registrant

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

Death

19. Provide supplemental information here