Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-0915
2. Registrant Information.
Registrant Reference Number: DASL111108
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.
08-NOV-11
5. Location of incident.
Country: UNITED STATES
Prov / State: OREGON
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. Unknown
Product Name: Outpost 22K
- Active Ingredient(s)
- PICLORAM (PRESENT AS ACID)
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
Yes
9. Application Rate.
6.4
Other Units: pt/acre
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).
THE TREATMENT AREA WAS ROADSIDE ROW THROUGH 2 RURAL SUBDIVISIONS. SPOT TREATMENT APPLICATIONS USING A 300 GALLON TRUCK MOUNTED SPRAYER AND HAND GUN. MIXTURE WAS 1 GALLON OUTPOST 22K PER 100 GALLONS OF WATER (1% SOLUTION). APPLICATION RECORDS INDICATE THAT HERBICIDE USE RATES EXCEEDED LABEL DIRECTIONS WITH RATES OF 6.4 TO 8.0 PT/ACRE APPLIED AT VARIOUS DATES BETWEEN JULY 12 AND AUGUST 4, 2010.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
No
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
Saint Bernard
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
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
12. How long did the symptoms last?
Persisted until death
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?
Other / Autre
specify unknown
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
THE STATE HAS RECEIVED A REPORT OF ONE ST BERNARD THAT DIED THE YEAR OF TREATMENT (2010). NAMES AND SPECIFICS UNKNOWN AS ALL INFORMATION WAS OBTAINED FROM 3RD PARTY SOURCES.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
APPLICATION OF OUTPOST 22K IN ROADSIDE RIGHTS-OF-WAY BY KLAMATH COUNTY PUBLIC WORKS (OREGON) FOR THE CONTROL OF KNAPWEED ALLEDGEDLY RESULTED IN 1 DOG (MORTALITY). INFORMATION IS BASED ON VERBAL INFORMATION OBTAINED.