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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-1038

2. Registrant Information.

Registrant Reference Number: A120121788

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.

Domestic Animal

4. Date registrant was first informed of the incident.

30-AUG-12

5. Location of incident.

Country: UNITED STATES

Prov / State: KENTUCKY

6. Date incident was first observed.

28-AUG-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. 62719-260-34704

Product Name: Crossbow L Herbicide

  • Active Ingredient(s)
    • 2,4-D (PRESENT AS LOW VOLATILE ESTERS)
      • Guarantee/concentration 34.4 %
    • TRICLOPYR
      • Guarantee/concentration 16.5 %

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).

The exposure was accidental and occurred at animal owner's yard. Owner sprayed an area in the yard with a slighter more concentrated solution than the label recommends. Dogs would have had access to treated areas right away. They did smell like the agent prior to bathing.

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

Chihuahua (Canine Domestic)

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

4.3

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Recumbent
    • Symptom - Ataxia
  • Eye
    • Symptom - Nystagmus
  • Skin
    • Symptom - Pale mucous membrane colour
  • Eye
    • Symptom - Pupil dilation
    • Specify - Mydriasis
    • Symptom - Other
    • Specify - corneal ulceration
  • Gastrointestinal System
    • Symptom - Diarrhea
  • Nervous and Muscular Systems
    • Symptom - Coma
  • Gastrointestinal System
    • Symptom - Vomiting
  • Blood
    • Symptom - Leukopenia
    • Specify - neutropenia
    • Symptom - Hyperglycemia
  • Cardiovascular System
    • Symptom - Hypotension
  • Blood
    • Symptom - Hypoglycemia
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Exposure involved unknown amount dermally. The exposure was accidental, and occurred at animal owner yard.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

Because the time course was poorly consistent, the amount was unknown and the findings were poorly consistent, this substance was considered to have doubtful likelihood of causing the clinical situation.

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Dog / Chien

3. Breed

Golden Retriever (Canine Domestic)

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

10

7. Weight (provide a range if necessary )

56

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
  • Nervous and Muscular Systems
    • Symptom - Ataxia
  • Gastrointestinal System
    • Symptom - Diarrhea
  • Nervous and Muscular Systems
    • Symptom - Anxiety
  • General
    • Symptom - Hyperthermia
  • Liver
    • Symptom - Elevated liver enzymes
    • Specify - elevated alkaline phosphatase

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

Exposure involved unknown amount dermally. The exposure was accidental, and occurred at animal owner yard.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Moderate

19. Provide supplemental information here

Because the time course was poorly consistent, the amount was unknown and the findings were poorly consistent, this substance was considered to have doubtful likelihood of causing the clinical situation.

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Dog / Chien

3. Breed

Chihuahua (Canine Domestic)

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2.5

7. Weight (provide a range if necessary )

8.7

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Subdued
  • Eye
    • Symptom - Pupil dilation
    • Specify - mydriasis
    • Symptom - Other
    • Specify - corneal ulceration
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Vomiting
  • Eye
    • Symptom - Other
    • Specify - anisocoria
  • Liver
    • Symptom - Elevated liver enzymes
    • Specify - elevated alkaline phosphatase
  • Nervous and Muscular Systems
    • Symptom - Trembling
  • General
    • Symptom - Hyperthermia

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

Exposure involved unknown amount dermally. The exposure was accidental, and occurred at animal owner yard.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Moderate

19. Provide supplemental information here

Because the amount was unknown consistent, the patient was considered to be at medium risk of developing clinical signs. If signs develop, there is low risk that those signs will be life-threatening.