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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-1413

2. Registrant Information.

Registrant Reference Number: SC1217825

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.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA


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. 14879      PMRA Submission No.       EPA Registration No.

Product Name: Lorsban 4E Insecticide

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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

Site: Res. - Out Home / Rés - à l'

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

A caller reports that a neighbor was spraying with a large ground sprayer in a farm field near his house around 4 PM on July 30. The caller states the he could smell the vapor drifting towards his house when he returned home around 8 PM on July 30. He called the retailer to find out what products they were using and they advised him it was Lorsban 4E mixed with water and a Bayer Crop Science fungicide. He states that the wind is still blowing towards his yard today.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.


  • Respiratory System
    • Symptom - Sore throat

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)

Drift from the application site

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?

>15 min <=2 hrs / >15 min <=2 h

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

Caller developed a sore throat not long after returning home around 8:00 PM on July 30. He mentions that his wife left and stayed at a neighbors and his mother, who lives on the street as well, closed all her windows and locked herself in. His sore throat went away that evening and did not seem to bother him but he reports that it has come back the next morning.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

Since the exposure happened outside in a well ventilated area and the product was diluted down, this type of exposure was not expected to cause the caller harm or be toxic. It could possibly cause some respiratory irritation but that would be expected to go away on its own with fresh air. The product can cause problems if the exposure is a large amount in a non well ventilated area, but with the exposure described and the way the product was prepared, it was not expected to cause the caller harm. It was recommended that the caller contact Bayer Crop Science for more information about the other product. If symptoms persist or worsen-seek medical evaluation.