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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2560

2. Registrant Information.

Registrant Reference Number: A120129836

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.

15-SEP-12

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

15-SEP-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. 27615      PMRA Submission No.       EPA Registration No.

Product Name: Vantage Plus Max Herbicide Solution

  • Active Ingredient(s)
    • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

110

Other Units: /7.5L

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).

Exposure involved unknown amount orally. The exposure was accidental, and occurred at animal owner yard. The caller's father diluted product at a ratio of 110 ml of product in 7.5 L water. Dog was outside during spraying and may have licked some of the treated areas.

To be determined by Registrant

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

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Miniature Pinscher

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

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

  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Drooling
  • Nervous and Muscular Systems
    • Symptom - Trembling
  • General
    • Symptom - Dehydration
  • Gastrointestinal System
    • Symptom - Salivating excessively
  • General
    • Symptom - Hypothermia
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
    • Specify - tremoring

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

Exposure involved unknown amount orally. The exposure was accidental, and occurred at animal owner yard. Owner diluted product at ratio of 110 ml product in 7.5 L water. Dog was outside during spraying and may have licked some treated areas. At about 13:00 the dog developed severe diarrhea, is tremoring, drooling, and is now dehydrated. Because the amount was unknown consistent, the patient was considered to be at unknown risk of developing clinical signs. If signs develop, there is low risk that those signs will be life-threatening.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here

Glyphosate is an amino acid inhibitor that affects the shikimic pathway in plants. Mammals do not have this pathway. Glyphosate is considered practically non-toxic via dermal and oral routes. However, the formulation frequently includes surfactants that can be irritating. Most yard use products will cause no more than mild self-limiting GI upset.