Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2091

2. Registrant Information.

Registrant Reference Number: 582897

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

Address: 450-1st Street SW, Suite 2100

City: Calgary

Prov / State: AB

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.

06-JAN-10

5. Location of incident.

Country: UNITED STATES

Prov / State: TENNESSEE

6. Date incident was first observed.

06-MAY-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.       PMRA Submission No.       EPA Registration No. 62719-260

Product Name: Crossbow Herbicide

• Active Ingredient(s)
  • 2,4-D (PRESENT AS ACID)
    • Guarantee/concentration 34.4 %
  • TRICLOPYR
    • Guarantee/concentration 16.5 %

---

7. b) Type of formulation.

Liquid

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 II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Muscle weakness
  • Symptom - Other
  • Specify - Neuropathy

• Skin
  • Symptom - Irritated skin

• Nervous and Muscular Systems
  • Symptom - Numbness

• Skin
  • Symptom - Tingling skin

4. How long did the symptoms last?

>6 mos / > 6 mois

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-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)

Unknown

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

1/6/2010 Caller spilled product on his skin eight months ago. Four days after the exposure, caller developed tingling on his feet which progressed to numbness and a burning sensation on his feet by the following morning. Caller developed weakness in his legs and hips three weeks after the initial symptoms developed. The weakness began to improve over time. Caller went to a chiropractor for an adjustment, but the adjustment did not improve the symptoms. Caller was seen by a doctor three weeks after weakness developed. No diagnosis was given, and caller was given pain medication and medication to help with the numbness in his feet. Caller was seen by a neurologist three months after the symptoms developed. Caller was diagnosed with neuropathy.

To be determined by Registrant

14. Severity classification.

Major

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. Any relationship between the use of this product, subsequent skin exposure to dilute material and the delayed insidious development of the complications reported in this case is inconceivable and lacks and biological plausibility. Sustained skin contact with this herbicide is typically associated with dermatitis and this condition was not reported in this case. When considering the body of regulatory data and post-marketing data as well as the weight of scientific peer reviewed evidence on the active ingredients used in this product such a causal relationship appears to be scientifically implausible.