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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2837

2. Registrant Information.

Registrant Reference Number: Prosar case# 1-22857275

Registrant Name (Full Legal Name no abbreviations): United Agri Products Canada, Inc.

Address: 789 Donnybrook Drive

City: Dorchester

Prov / State: Ontario

Country: Canada

Postal Code: N0L1G5

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

Domestic Animal

4. Date registrant was first informed of the incident.

02-JUN-10

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

02-JUN-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. 27884      PMRA Submission No.       EPA Registration No.

Product Name: Par III Turf Herbicide

  • Active Ingredient(s)
    • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
    • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
    • MECOPROP (PRESENT AS AMINE SALT)

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).

On 6/2/10, the dog ran through diluted product spray and developed symptoms within an hour of the exposure.

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

Golden Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>1 yr / > 1 an

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

  • Skin
    • Symptom - Red skin
  • General
    • Symptom - Swelling
    • Specify - Swelling around both eyes and on the muzzle

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?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

specify The dog ran through diluted product spray and developed symptoms within an hour of the exposure.

17. Provide any additional details about the incident

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

1-22857275: The reporter, a veterinarian, called on 6/2/10 to report the exposure of a 1 year old female Golden Retriever earlier in the day to a lawn and garden product containing the active ingredients 2,4-D, Dicamba, and MCPP. According to the reporter, the dog ran through diluted product spray and developed symptoms within an hour of exposure. Symptoms included swelling around both eyes and muzzle, along with erythema of the paws. The irritant potential of the product was discussed, along with the fact that no systemic toxicity would be expected. A recommendation was made to perform dermal decontamination, and to treat symptomatically with medications such as diphenhydramine, corticosteroids, and/or topical medications. The veterinarian was encouraged to also rule out allergic reactions to an insect bite/sting. Contact with the reporter was re-established on 6/7/10. She had spoken with the owners the night of 6/2/10, who had revealed that the dog's right eye was still swollen. The veterinarian did not have any other details.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here