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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2011-2414

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1 26436268

Registrant Name (Full Legal Name no abbreviations): Loveland Products, Inc.

Address: P.O. Box 1286 80632 1286

City: Greeley

Prov / State: Colorado

Country: USA

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

Human

4. Date registrant was first informed of the incident.

08-JUN-11

5. Location of incident.

Country: UNITED STATES

Prov / State: KANSAS

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. 34704-125

Product Name: Low Vol 6 Ester Weed Killer

  • Active Ingredient(s)
    • 2,4-D (PRESENT AS LOW VOLATILE ESTERS)
      • Guarantee/concentration 88.8 %

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: unspecified crop

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

The caller reported her father spraying dilute product 1 quart to 100 gallons of water, the product was applied over five acres. The crop was unspecified.

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: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

  • Respiratory System
    • Symptom - Coughing
    • Symptom - Coughing up blood
    • Symptom - Respiratory irritation
  • Gastrointestinal System
    • Symptom - Nausea
  • Respiratory System
    • Symptom - Other
    • Specify - Lungs were inflamed, full of lesions, and filling up with blood
    • Symptom - Shortness of breath
  • General
    • Symptom - Death

4. How long did the symptoms last?

Persisted until death

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

Yes

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Unknown

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

Application

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?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>3 days <=1 wk / >3 jours <=1 sem

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.)

1 26436268 The reporter indicates exposure of a family member to an herbicide containing the active ingredient isooctyl ester of 2, 4 D. The reporter indicates his father was working with the product five weeks prior to his initial contact with the registrant. The reporter did not clarify in what capacity his father was working with the product or what crop he was working with. He indicated his father had diluted the product one quart product to one hundred gallons of water and applied the mixture to a five acre lot. He reports the product was sprayed and the day was windy. He indicated he did not believe his father used any personal protective equipment such as a respirator. A discreet exposure incident was not described, but respiratory exposure was assumed by the caller. The caller stated one week following use his father developed nausea, coughing and wheezing. The caller stated after one additional week his father started to cough up small amounts of blood and developed difficulty breathing. The caller stated at this point his father was brought to a veteran s administration hospital unspecified and treated. The caller was distraught during his report and did not provide detail regarding treatments diagnostics done or if his father was hospitalized. The caller indicated his father s symptoms progressed and his lungs were inflamed, covered with lesions, and filled with blood. The caller indicated a short time later his father passed away. He did not provide details regarding where or when his father died. The caller reported an autopsy was pending. He asked about expected symptoms following inhalation exposure. The caller was advised of the potential respiratory irritant effect following inhalation exposure to diluted product and that underlying respiratory diseases can compound that effect. The caller was advised the time line and severity of symptoms seen in this circumstance was inconsistent with the toxicity profile of the active ingredient and the described use. Follow up is pending on this case. An effort to contact the reporter will be made after a sufficient amount of time has elapsed that autopsy results may be available.

To be determined by Registrant

14. Severity classification.

Death

15. Provide supplemental information here.