Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-3399
2. Registrant Information.
Registrant Reference Number: A120060775
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.
10-MAY-12
5. Location of incident.
Country: UNITED STATES
Prov / State: OREGON
6. Date incident was first observed.
07-MAY-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)
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 %
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 524-308
Product Name: Roundup Herbicide
- Active Ingredient(s)
- GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
- Guarantee/concentration 41 %
PMRA Registration No.
PMRA Submission No.
EPA Registration No. Unknown
Product Name: 2,4-D
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 71995-8-239
Product Name: Ortho Total Kill Weed and Grass Killer Ready to Use
- Active Ingredient(s)
- GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
- Guarantee/concentration .96 %
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).
On Monday, May 7, 2012 in the late afternoon, the neighbor had sprayed Crossbow, Roundup, 24D, and Total Kill weed killer. The owner does not know the exact products.
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
Dog / Chien
3. Breed
Miniature Schnauzer (named Jenny)
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
5
7. Weight (provide a range if necessary )
20
lbs
8. Route(s) of exposure
Unknown
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 - Vomiting
- Symptom - Bloody diarrhea
12. How long did the symptoms last?
>8 hrs <=24 hrs / > 8 h < = 24 h
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 Monday, May 7th in the late afternoon, the neighbor had sprayed Crossbow, Roundup, 24D, and Total Kill weed killer. The owner did not know the exact products. The 4 dogs (Jenny, Reggie, Dakota and Jack) were exposed to the yard where the neighbor sprayed. On Tuesday, May 8th, all of the dogs started vomiting continually. There was only phlegm and food in the vomit. The next day, they all had bloody diarrhea. At 3AM (5:00 CT) on May 9th, the owner took the dogs to the Veterinarian and they were placed on fluids and care was administered. Jenny died on May 9th. Reggie and Dakota were getting worse, and Jack was about the same.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
Miniature Schnauzer (named Jack)
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
6
7. Weight (provide a range if necessary )
19
lbs
8. Route(s) of exposure
Unknown
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 - Vomiting
- Symptom - Bloody diarrhea
12. How long did the symptoms last?
Unknown / Inconnu
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
Unknown/Inconnu
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 Monday, May 7th in the late afternoon, the neighbor had sprayed Crossbow, Roundup, 24D, and Total Kill weed killer. The owner did not know the exact products. The 4 dogs (Jenny, Reggie, Dakota and Jack) were exposed to the yard where the neighbor sprayed. On Tuesday, May 8th, all of the dogs started vomiting continually. There was only phlegm and food in the vomit. The next day, they all had bloody diarrhea. At 3AM (5:00 CT) on May 9th, the owner took the dogs to the Veterinarian and they were placed on fluids and care was administered. Jenny died on May 9th. Reggie and Dakota were getting worse, and Jack was about the same.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
Golden Retriever (named Reggie)
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
4
7. Weight (provide a range if necessary )
80
lbs
8. Route(s) of exposure
Unknown
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 - Bloody diarrhea
- Symptom - Vomiting
12. How long did the symptoms last?
Unknown / Inconnu
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
Unknown/Inconnu
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 Monday, May 7th in the late afternoon, the neighbor had sprayed Crossbow, Roundup, 24D, and Total Kill weed killer. The owner did not know the exact products. The 4 dogs (Jenny, Reggie, Dakota and Jack) were exposed to the yard where the neighbor sprayed. On Tuesday, May 8th, all of the dogs started vomiting continually. There was only phlegm and food in the vomit. The next day, they all had bloody diarrhea. At 3AM (5:00 CT) on May 9th, the owner took the dogs to the Veterinarian and they were placed on fluids and care was administered. Jenny died on May 9th. Reggie and Dakota were getting worse, and Jack was about the same.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
Siberian Husky (named Dakota)
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
5
7. Weight (provide a range if necessary )
75
lbs
8. Route(s) of exposure
Unknown
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 - Bloody diarrhea
- Symptom - Vomiting
12. How long did the symptoms last?
Unknown / Inconnu
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
Unknown/Inconnu
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 Monday, May 7th in the late afternoon, the neighbor had sprayed Crossbow, Roundup, 24D, and Total Kill weed killer. The owner did not know the exact products. The 4 dogs (Jenny, Reggie, Dakota and Jack) were exposed to the yard where the neighbor sprayed. On Tuesday, May 8th, all of the dogs started vomiting continually. There was only phlegm and food in the vomit. The next day, they all had bloody diarrhea. At 3AM (5:00 CT) on May 9th, the owner took the dogs to the Veterinarian and they were placed on fluids and care was administered. Jenny died on May 9th. Reggie and Dakota were getting worse, and Jack was about the same.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here