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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2783

2. Registrant Information.

Registrant Reference Number: SC990624

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.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA


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.


PMRA Registration No. 29973      PMRA Submission No.       EPA Registration No.

Product Name: Attain XC A

  • Active Ingredient(s)

PMRA Registration No. 25465      PMRA Submission No.       EPA Registration No.

Product Name: Prestige A Herbicide

  • Active Ingredient(s)

PMRA Registration No. 29972      PMRA Submission No.       EPA Registration No.

Product Name: Attain XC B

  • Active Ingredient(s)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Puma

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Unspecified

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

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

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


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: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.


  • Eye
    • Symptom - Blurred vision
  • Nervous and Muscular Systems
    • Symptom - Ataxia
    • Symptom - Disorientation

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


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


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

Chemical resistant gloves


10. Route(s) of exposure.


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.)

The caller reported that on Friday, June 8 he was spraying a tank-mix of Attain and Puma 6 days ago. He does not recall any defined point of exposure to the liquid herbicides but speculates that his respirator had been broken so some of the vapours from the mixture may have got through. He initially felt fine the day of herbicide application. During the afternoon of the following day, June 9, the caller states that after drinking a beer he developed blurred vision, disorientation and ataxia. He states he felt like he was 'drunk'. He does not typically experience these symptoms after one beer. Because these symptoms did not improve he ended up going to a local ER on June 10. They performed unspecified blood work and a CT scan which all came back normal. No treatment was performed and he was sent home. He reports that he is still experiencing the symptoms. The next day he went to his physician where tests and CT were all normal. At the time of the call the symptoms had abated somewhat.

To be determined by Registrant

14. Severity classification.


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. Direct exposure to this herbicide is not evident in this incident. The delayed onset of the patient symptoms after application is not suggestive of toxicity nor would they be expected symptoms should incidental contact to airborne vapors have occurred. It would appear that this patient's complications are more consistent with the patient's consumption of an alcoholic beverage, however, such sustained symptoms are inconsistent with ethanol intoxication.