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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3098

2. Registrant Information.

Registrant Reference Number: 10070601

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.


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: TEXAS

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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 228-145

Product Name: Weedestroy AM-40

  • Active Ingredient(s)
      • Guarantee/concentration 47.3

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Bitterweeds

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

Rate 2.5 gallons in 300 gallons of water. Tank mixed with Surmount (Dow) and Graze-on P +D (Dow).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


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: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.


  • Nervous and Muscular Systems
    • Symptom - Paralysis
    • Symptom - Slurred speech
  • Eye
    • Symptom - Other
    • Specify - eye control abnormalities on right side of his face
  • Gastrointestinal System
    • Symptom - Difficulty swallowing
    • Specify - ability to swallow inhibited
    • Symptom - Anorexia
    • Specify - ability to eat inhibited
    • Symptom - Dry mouth
    • Specify - ability to salivate inhibited

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


8. How did exposure occur? (Select all that apply)

Poisoning from ingestion of the pesticide

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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.)

In the tractor cab, the suction line broke, pressure caused explosion and he got some of this diluted product in his mouth. Also tank mixed with 2 of dow's products. Three days following use of and exposure to this product, he developed partial paralysis, slurred speech, eye control abnormalities on the right side of his face. He states that most of the paralysis has subsided, though smiling is still one-sided , and if he were to put a "jeweler's magnifying glass" in the right eye orbit, he would not be able to hold it (where as he can on the left side). He states also that his speech and ability to salivate and eat and swallow was greatly impaired until recently, and he lost 17 pounds during the past month as a result. He has been seen by neurologists and they have performed many tests which have borne negative results, and they have ruled out "Bell's Palsy" as a diagnosis.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

Caller wanted to know weather the oral exposure tot his product could be the cause of this condition. Prosar explained typical symptoms.