Health Canada
www.hc-sc.gc.ca
Common menu bar links
Consumer Product Safety
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-2116
2. Registrant Information.
Registrant Reference Number: AM01
Registrant Name (Full Legal Name no abbreviations): Arysta Life Sciences America Inc.
Address: 1450 Broadway, 7th Floor
City: New York
Prov / State: NY
Country: USA
Postal Code: 10018
3. Select the appropriate subform(s) for the incident.
Scientific Study
4. Date registrant was first informed of the incident.
5. Location of incident.
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.
Active(s)PMRA Registration No. 23485 PMRA Submission No. EPA Registration No.
Product Name: Amitraz Technical (Insecticide)
- Active Ingredient(s)
- AMITRAZ
7. b) Type of formulation.
Application Information
8. Product was applied?
Unknown
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform VII: Scientific Study
1. Study Reference
Title Acute Neurotoxicity Study of Amitraz in Rats
Date 01-JUN-07
2. a) Is an extension needed to translate the document?
No
3. Type of incident identified in the study
New health or environmental hazard
4. Describe the incident identified in the study (e.g. study demonstrates an increased risk to non-Hodgkin's Lymphoma after exposure to pesticide X)
None, this is simply a study that has just been made available to the registrant
5. a) Was the study discontinued before completion?
No
