Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3458

2. Registrant Information.

Registrant Reference Number: SC828580

Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.

Address: 450-1st Street SW, Suite 2100

City: Calgary

Prov / State: AB

Country: Canada

Postal Code: T2P 5H1

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

Human

4. Date registrant was first informed of the incident.

29-JUL-11

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

22-JUL-11

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)

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PMRA Registration No. 22764      PMRA Submission No.       EPA Registration No.

Product Name: Curtail M Herbicide

• Active Ingredient(s)
  • CLOPYRALID
  • MCPA (PRESENT AS ESTERS)

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Pub. Area - Outdoor/Zone publique - ext

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

See narrative in section 13 of subform II.

To be determined by Registrant

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

No

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Medical Professional

2. Demographic information of data subject

Sex: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Weakness
  • Symptom - Malaise

• Skin
  • Symptom - Erythema
  • Symptom - Peeling skin
  • Symptom - Rash

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Occupational

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

Contact with treated area

Amount of time between application and contact 2

Day(s) / Jour(s)

What was the activity? Please refer to field 13 on Subform II or field 17 of subform III

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

None

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

>8 hrs <=24 hrs / > 8 h < = 24 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.)

7/29/2011 Caller cuts grass at a golf course. He states that he had cut the grass about 2-3 days after Curtail had been applied to the grass on the course. There had been heavy rainfall between the time of application and the time he mowed. He thinks he may have been exposed to the Curtail because he used his hands to clear the grass and mud from the clogged lawn mower. He was wearing landscaping gloves with rubber palms and cotton tops at the time. About 1 day after mowing, he developed peeling, redness and a rash on his hands. About 3 days after mowing he experienced some generalized malaise and leg weakness. He saw his regular general practitioner who was unable to determine a cause but prescribed a topical cream. The skin problem appears to be resolving but he still feels weak. The subject did state he suffers from Parkinson's Disease for which he takes medications. It was suggested he talk to his neurologist, as well.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.