Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-1153

2. Registrant Information.

Registrant Reference Number: IRF 181

Registrant Name (Full Legal Name no abbreviations): Chemtura Canada Co./Cie

Address: 25 Erb Street

City: Elmira

Prov / State: Ontario

Country: Canada

Postal Code: N3B 3A3

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

Domestic Animal

4. Date registrant was first informed of the incident.

04-NOV-13

5. Location of incident.

Country: UNITED STATES

Prov / State: OHIO

6. Date incident was first observed.

23-JUL-13

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. 400-536-2724

Product Name: Clarifly Larvicide

  • Active Ingredient(s)
    • DIFLUBENZURON
      • Guarantee/concentration .67 %

7. b) Type of formulation.

Granular

Application Information

8. Product was applied?

Yes

9. Application Rate.

3.04

Other Units: g/lb

10. Site pesticide was applied to (select all that apply).

Site: Other / Autre

Préciser le type: mixed with cattle feed

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

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

Animal's Owner

2. Type of animal affected

Horse / Cheval

3. Breed

Belgian Heavy Draft Horse

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

9

7. Weight (provide a range if necessary )

2000

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Skin
    • Symptom - Hives

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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

There was 3.04 grams/lb. of this product added to the cattle feed. The horse broke out of its pen around 7am and ate about 2-4 lbs of the treated cattle feed. Around 9am, the owner noticed hives on the horses back and belly that he believed may be an allergic reaction from the product. Hives are a sign of a hypersensitivity reaction, which can be a response to many different exposures. Owner was advised by a Dr. (name) that the exposure is not expected to be life-threatening, as it does not sound liek it could be an allergic reatcion. Advised to avoid any feed-through products with the same active ingredients in th efuture fo rthe horse.


To be determined by Registrant

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

Minor

19. Provide supplemental information here