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Consumer Product Safety

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-10

5. 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

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.