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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5461

2. Registrant Information.

Registrant Reference Number: Prosar 1-20798816

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.

20-NOV-09

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

20-NOV-09

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. 28573      PMRA Submission No.       EPA Registration No.

Product Name: Aim EC CANADA

  • Active Ingredient(s)
    • CARFENTRAZONE-ETHYL

7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

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).

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

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Unknown breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Salivating excessively
  • General
    • Symptom - Other
    • Specify - Refuses to open mouth

12. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-20798816: A reporter (dog owner) called on 11/20/2009 to report the exposure of his dog to an herbicide containing the active ingredient Carfentrazone-ethyl. According to the reporter, a container of product had been run over and was lying in the road. His dog licked a small amount of the product off the road 30 minutes prior to the report and was salivating and refusing to open her mouth. The reporter was advised that significant effects are not expected following small ingestions of the product. Salivation may be secondary to nausea or oral irritation. A recommendation was made to offer some food or water flavored with chicken broth to try and encourage the dog to rinse her mouth. The reporter was also advised that the product does contain a high percentage of hydrocarbons which, if aspirated, can result in significant lung injury. The reporter was further advised that aspiration risk is likely very low with the described exposure. A recommendation was made to have the dog evaluated by a veterinarian should severe vomiting/diarrhea or difficulty breathing occur. On follow up, the reporter stated that the dog was given chicken broth and her signs resolved the following day. No further information was obtained.


To be determined by Registrant

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

Minor

19. Provide supplemental information here