Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-0347

2. Registrant Information.

Registrant Reference Number: 110078611

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

Address: Suite 2100, 450 - 1st Street S.W.

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2P 5H1

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

Domestic Animal

4. Date registrant was first informed of the incident.

23-JUN-11

5. Location of incident.

Country: UNITED STATES

Prov / State: MISSOURI

6. Date incident was first observed.

23-JUN-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.       PMRA Submission No.       EPA Registration No. 62719-260

Product Name: Crossbow Weed and Brush Killer

• Active Ingredient(s)
  • 2,4-D (PRESENT AS LOW VOLATILE ESTERS)
    • Guarantee/concentration 34.4
  • TRICLOPYR
    • Guarantee/concentration 16.5

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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: Res. - Out Home / Rés - à l'ext.maison

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

The product had been sprayed in the owner's back yard. The vet staff was unsure if the cat was exposed or not, and they are unsure of how the product was used.

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

Other

2. Type of animal affected

Cat / Chat

3. Breed

Feline Domestic

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Skin
  • Symptom - Jaundice
  • Specify - Icterus

• General
  • Symptom - Lethargy

• Eye
  • Symptom - Other
  • Specify - Ocular Hemorrhage

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Yes

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

On presentation, the cat had blood coming from the nose, behind the eye, and was icteric. He's been given vitamin K1. Per vet staff, the pet died shortly after consultation.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

Based on discussions with the vet, the product had been used in the yard, and they're not sure if the cat had exposure or not. On presentation, the cat has blood coming from the nose, behind the eye, and is icteric. He's been given vitamin K1. If this was diluted and used per label, would not expect systemic signs. The kerosene could cause dermal irritation and possibly breathing changes if groomed, or if ingested undiluted. Other signs of concentrated exposures would be vomiting, tremors, ataxia, and possibly oral ulceration. Would be more suspicious of possibly an anticoagulant, trauma, or severe liver disease.