Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-1639
2. Registrant Information.
Registrant Reference Number: 90114669
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.
Domestic Animal
4. Date registrant was first informed of the incident.
14-OCT-09
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
12-OCT-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. 28434
PMRA Submission No.
EPA Registration No.
Product Name: Garlon Ultra Herbicide
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: Res. - Out Home / Rés - à l'ext.maison
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
The product was applied in the owner's yard around the house on October 8, 2009.
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
Dog / Chien
3. Breed
Chow Chow Mix
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
8
7. Weight (provide a range if necessary )
45
lbs
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
12. How long did the symptoms last?
>3 days <=1 wk / >3 jours <=1 sem
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
Unknown/Inconnu
16. How was the animal exposed?
Other / Autre
specify orally
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Because the amount was poorly consistent, the patient was considered to be at low risk of developing clinical signs. If signs develop, there is a low risk that those signs will be life-threatening. If the dog licked some foliage soon after it was sprayed, we could see some mild anorexia or vomiting. Once the product was dry after the original application, we would not expect any further signs. Licking several days after the product was applied is unlikely related to the product.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here
The dog has a history of seizures when she is introduced to new chemicals. Is not currently taking any medications. When the area around the house was treated with Garlon, the owner noticed that the dog was showing behavior signs associated with a seizure, but did not have one yet.