Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3393

2. Registrant Information.

Registrant Reference Number: SC1008864

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

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

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2P 5H1

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

Human

Domestic Animal

4. Date registrant was first informed of the incident.

17-JUL-12

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

14-JUL-12

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. 14879      PMRA Submission No.       EPA Registration No.

Product Name: Lorsban 4E Insecticide

• Active Ingredient(s)
  • CHLORPYRIFOS

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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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: unknown

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

The caller states that his neighbors were spraying the product on crops using an airplane on July 14, 2012. His cattle were up against the fence on the side of his property adjacent to the farm field that was being sprayed. The caller reports that he thinks there was a significant drift of the spray as it was a hot, windy day. He did not actually witness the airborne spray landing on the cattle as he was inside his home at the time. A 2-day old calf became ill on the evening of July 14, 2012 and the owner treated with Nuflor, electrolytes and CalfSpan bolus for diarrhea. The calf was having diarrhea and a slight change in breathing on July 14. The electrolytes were administered with a bottle and the calf seem to vomit or regurgitate part of it. By the next morning the calf had expired. A veterinarian was not contacted and the farmer is not pursuing an autopsy.

To be determined by Registrant

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

Unknown

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Diarrhea

• Nervous and Muscular Systems
  • Symptom - Headache
  • Symptom - Muscle pain

4. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Drift from the application site

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.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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.)

An adjacent neighbor was spraying by airplane their crops with Lorsban 4E. The farmer felt symptoms of headache, body aches and diarrhea 24 hrs post application of the product. The farmer was not outside during the spraying and did not describe any defined point of contact with the liquid insecticide. He also admits that he may have a "bug" of some sort, but just not sure. A medical professional explained to the farmer that although some symptoms he has reported are consistent with organophosphate toxicity, but these would not be expected if the product is diluted and used per product directions. Also explained that his flu-like symptoms appearing greater than 24 hrs after product exposure are not consistent with product exposure.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Cow / Vache

3. Breed

Boivine

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Respiratory

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Diarrhea

• Respiratory System
  • Symptom - Dyspnea

• General
  • Symptom - Death

• Respiratory System
  • Symptom - Other
  • Specify - slight change in breathing

12. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Spray drift / Dérive de pulvérisation

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

A 2-day old calf became ill on the evening of July 14, 2012 and the owner treated with Nuflor, electrolytes and CalfSpan bolus for diarrhea. The calf was having diarrhea and a slight change in breathing. The electrolytes were administered with a bottle and the calf seem to vomit or regurgitate part of it. By the next morning the calf had expired. A veterinarian was not contacted and the farmer is not pursuing an autopsy. The 2-day old calf did not have a postmortem exam. Calf symptoms were diarrhea, and dyspnea just prior to time of death and expired despite supportive measures. No other livestock have fallen ill. A medical professional explained that a 2-day old calf can have multiple complications based on symptoms reported, and that a postmortem exam would have been useful to him. Correct use of product would not likely result in complications to the calf or to him.

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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