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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-3000
2. Registrant Information.
Registrant Reference Number: x
Registrant Name (Full Legal Name no abbreviations): x
Address: x
City: x
Prov / State: x
Country: x
Postal Code: X
3. Select the appropriate subform(s) for the incident.
Human
4. Date registrant was first informed of the incident.
5. Location of incident.
Country: CANADA
6. Date incident was first observed.
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-P (PRESENT AS DIMETHYLAMINE SALT)
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
1Units: %
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).
Hose end sprayer. Application rate: 1% mixture for 1000L tank. Site:lawn 9' from our house and 20' from garage. 24D smell stayed in garage same lenght of time as inside of house. Foundation of the house next door was wet, so was 6"-10" of our driveway. Lawn dandelions were killed (within a week).The doctor confirmed that I have severe sensitivity to 2,4-D. I do not have asthma or a cold. Headache and bad sensation in the throat, nose were gone same time the odour was not there. Also told me to keep doors, windows shut and preferably leave the premises during spraying. Spraying 2,4-D was done too close to living quarters, with windows open in an urban area. My doctor thought that 2,4-D was prohibited in the city yet a professional spraying company told me that they are fully licensed to use 2,4-D in their spraying.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: Female
Age: Unknown / Inconnu
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- General
- Symptom - Other
- Specify - throat/sinus sensation
- Gastrointestinal System
- Symptom - Nausea
- General
- Symptom - Malaise
- Gastrointestinal System
- Symptom - Vomiting
- Respiratory System
- Symptom - Respiratory pain
- Specify - sore chest below collarbone
4. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
5. Was medical treatment provided? Provide details in question 13.
Unknown
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)
Contact with treated area
What was the activity? inhaling 2-4-d fumes
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.
Respiratory
11. What was the length of exposure?
>24 hrs <=3 days / >24 h <=3 jours
12. Time between exposure and onset of symptoms.
>30 min <=2 hrs / >30 min <=2 h
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.)
Severe headache and awful throat/sinus sensation immediately after inhaling 2,4-D fumes. I am extremely sensitive to smoke, this incident was worse. Nausea set in. I fell asleep 3am waking @ 7pm w/bad headache & the awful sensation@the back of the throat. Left home for an hour - returned and vomited. Then again an hour later. Nauseated and too sick to go to the clinic. Better next day but headachy, sore chest below collar bone. Few days later the doctor ordered bloodwork. Chemical sensitivity. Being outside & breathing / also inside. Next door lawn sprayed for weeds. Area sprayed was 9' from our entrance. 3 windows were open. We could not get rid of the odour as the outside 2,4-D smell lingered for 2 days or 48 hrs. I was working in my back yard when spraying took place, forgot about open windows. (I was not notified that the yard was being professionally sprayed. I was outside about an hour trying to get things done, it rained but the odour did not dissipate till 2 days later.
