Health Canada
www.hc-sc.gc.ca
Common menu bar links
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-3096
2. Registrant Information.
Registrant Reference Number: 10061401
Registrant Name (Full Legal Name no abbreviations): Nufarm Agriculture Inc
Address: 5507 1st St SE
City: Calgary
Prov / State: Alberta
Country: Canada
Postal Code: T2H 1H9
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
14-JUN-105. Location of incident.
Country: UNITED STATES
Prov / State: WYOMING
6. Date incident was first observed.
Unknown
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. 71368-65
Product Name: Credit Extra Herbicide
- Active Ingredient(s)
- GLYPHOSATE
- Unknown
- GLYPHOSATE
7. b) Type of formulation.
Liquid
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: Field / pasture
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Caller diluted 1 quart to 25 gallons of water on 06/04/2010. Allowed horses back into the treated area sometime around 06/12/2010.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
Animal's Owner
2. Type of animal affected
Horse / Cheval
3. Breed
Quarter Horse
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
10
7. Weight (provide a range if necessary )
1180
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Loss of coordination
- Specify - Lack of balance
- General
- Symptom - Death
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Died
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
5 horses allowed back into the treated area sometime around 06/12/2010. He states he has 5 horses now that have balance issues - "they lack balance" and hiss favorite horse (Sugar, 10 year old quarter horse, 1180lbs) developed symptoms of colic and passed away today (06/14/2010). The caller stated Sugar had a history of colic, so he does not know if it was related to the product or not.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Caller contacted the DVM who suggested he contact the company. Caller has removed the remaining 5 horses from the pasture and is wondering what else he should do. Prosar recommended contacting Nufarm for re-entry interval for chemical and discussed symptoms of exposure.
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Horse / Cheval
3. Breed
Quarter horse
4. Number of animals affected
5
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Loss of coordination
- Specify - lack of balance
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Not recovered / Non rétabli
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
5 horses allowed back into the treated area sometime around 06/12/2010. He states he has 5 horses now that have balance issues - "they lack balance" and hiss favorite horse (Sugar, 10 year old quarter horse, 1180lbs) developed symptoms of colic and passed away today (06/14/2010). The caller stated Sugar had a history of colic, so he does not know if it was related to the product or not.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
Caller contacted the DVM who suggested he contact the company. Caller has removed the remaining 5 horses from the pasture and is wondering what else he should do. Prosar recommended contacting Nufarm for re-entry interval for chemical and discussed symptoms of exposure.
