Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-1630

2. Registrant Information.

Registrant Reference Number: SC501301

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

Address: Suite 2100, 450 - 1st Street S.W.

City: Calgary

Prov / State: Alberta

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.

13-JUL-09

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

12-JUL-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)

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PMRA Registration No. 26649      PMRA Submission No.       EPA Registration No.

Product Name: Grazon Herbicide (Canada)

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
  • PICLORAM (PRESENT AS AMINE SALTS)

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7. b) Type of formulation.

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: unknown

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.

Medical Professional

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Dry eye

• Gastrointestinal System
  • Symptom - Dry mouth

• Nervous and Muscular Systems
  • Symptom - Dizziness

• General
  • Symptom - Polydipsia
  • Specify - Increased thirst

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

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

No

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)

Goggles

Chemical resistant gloves

Respirator

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

>2 hrs <=8 hrs / > 2 h < = 8 h

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.)

Initial call on July 13, 2009 - Caller used product yesterday while spraying crops. He wore protective eye goggles, rubber gloves and a nasal respirator. He states that he applied the product for a total of 4 hrs, while it was windy outside. He did not relate there was a point when he knew product had touched him dermally or that he inhaled any airborne spray. He did state that he was able to bathe and wash soon after he completed the application. Approximately 7 hours later, he woke in his bed feeling excessive thirst, dry eyes, and dizzy. Follow-up call on July 15, 2009 - The patient was eventually seen by a physician. Unspecified blood tests, x-rays and an EKG were unremarkable. The physician indicated that he was unable to find anything objectively wrong with the patient to explain the subjective symptoms reported by this patient. No specific treatment was applied. The patient states that he is feeling better but continues to experience dry mouth and dizziness when he sweats.

To be determined by Registrant

14. Severity classification.

Minor

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. The symptoms as reported are not suggestive of toxicity from this herbicide, nor would such symptoms be expected even had incidental skin contact with the liquid herbicide occurred during application. The symptoms reported by this patient are consistent with heat exhaustion or dehydration, however, such symptoms are not typically so protracted.