Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-1640

2. Registrant Information.

Registrant Reference Number: 90115374

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.

12-NOV-09

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

14-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. 21053      PMRA Submission No.       EPA Registration No.

Product Name: Garlon 4 Herbicide

  • Active Ingredient(s)
    • TRICLOPYR

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: Other / Autre

Préciser le type: field or pasture

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

unknown

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

Bird / Oiseau

3. Breed

Mountain Bluebird

4. Number of animals affected

1

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

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

11. List all symptoms

System

  • Respiratory System
    • Symptom - Other
    • Specify - subcutaneous emphysema

12. How long did the symptoms last?

Unknown / Inconnu

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

Exposure occurred at other field/pasture and the area around the nest box was sprayed twice in June 2008. Because the amount was unknown consistent, the patient was considered to be at unknown risk of developing clinical signs. If signs develop, there is unknown risk that those signs will be life-threatening. Risk of GI upset with oral ingestion, dermal irritation from cutaneous contact and potentially dyspnea with inhalation. Subcutaneous emphysema can occur from trauma, infectious diseases, and toxic exposures, but it would be impossible to draw a cause and effect with this bird's signs and the reported agent without further information. Because the time course was somewhat consistent, the amount was unknown consistent, and the findings were poorly consistent, this substance was considered to have low likelihood of causing the clinical situation. Email from caller showed photo of the nestling is consistent with subcutaneous emphysema.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here