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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2482

2. Registrant Information.

Registrant Reference Number: 2010-15

Registrant Name (Full Legal Name no abbreviations): BASF Canada

Address: 100 Milverton, 5th floor

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5R4H1

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

30-MAY-10

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

30-MAY-10

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. 24407      PMRA Submission No.       EPA Registration No.

Product Name: CONQUEST (PURSUIT component)

  • Active Ingredient(s)
    • IMAZETHAPYR

PMRA Registration No. 24406      PMRA Submission No.       EPA Registration No.

Product Name: CONQUEST(Sencor component)

  • Active Ingredient(s)
    • METRIBUZIN

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: unknwn

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

Neighbours applied product to their fields sometime in last few weeks

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

German shepard dog mix

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

27.9

kg

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

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Salivating excessively
  • Nervous and Muscular Systems
    • Symptom - Trembling
    • Symptom - Seizure
  • Cardiovascular System
    • Symptom - Abnormally fast heart rate
    • Symptom - Tachycardia

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

Unknown

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

In discussions with vet,pointed out that symptoms suggested OP poisoning


To be determined by Registrant

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

Major

19. Provide supplemental information here

Imazethapyr has a good margin of safety, although with large ingestions, GI upset and potentially CNS,CV and respiratory depression are possible. Metribuzin has reportedly (poisendex) caused muscle twitching,ataxia and spasms/tetany. Timecourse unknown consistent, amount unknown consistent, findings generally consistent, medium likelihood of causing clinical situation