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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-4607

2. Registrant Information.

Registrant Reference Number: SC1209625

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.


Prov / State: ARKANSAS

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.       PMRA Submission No.       EPA Registration No. 62719-625

Product Name: Transform WG Insecticide

  • Active Ingredient(s)

7. b) Type of formulation.

Dry Flowable (water dispersible granules)

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: unknown

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

Farmer was preparing to mix product for dilution and briefly inhaled some of the dust and got some of the material on his hands. It is not known how long he continued to work with product after exposure. Farmer was not wearing gloves or mask or other protective gear, and was working out in high heat and humidity environmental conditions.

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.

Medical Professional

2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.


  • Cardiovascular System
    • Symptom - Tachycardia
  • Nervous and Muscular Systems
    • Symptom - Dizziness
    • Specify - vertigp
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Nausea
    • Symptom - Vomiting
  • Eye
    • Symptom - Blurred vision
  • Nervous and Muscular Systems
    • Symptom - Muscle cramps

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)


10. Route(s) of exposure.



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.)

Farmer reported that about 24h post exposure he began to have blurred vision, diarrhea, dizziness, vomiting, muscle cramps, and nausea. RN (caller) states he was directly admitted to (hospital name), (city, state). Farmer received supportive care and other causes were being investigated, i.e. heat stroke and dehydration. Toxicity information from the MSDS was reviewed by medical professional. Mammalian toxicity is very low with a dermal LD50 of 5000 mg/kg and an oral LD50 of 2000 mg/kg. Explained to RN that the delay in symptom development does not fit a good temporal relationship with exposure. If exposure was significant, symptoms would be expected to be observed within 1-2 hrs.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

Given the known toxicity profile of this formulation (oral LD50 2000 mg/kg, dermal LD50 5000 mg/kg) the level of exposure reported in this incident would not be expected to produce delayed and significant systemic illness resulting in hospitalization. A differential diagnosis consisting of heat stroke and dehydration appears to be a more likely etiology.