Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-1868

2. Registrant Information.

Registrant Reference Number: A140003571

Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.

Address: Suite 2100, 450-1st Street S.W.

City: Alberta

Prov / State: Calgary

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.

10-JAN-14

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

19-DEC-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 62719-527

Product Name: Garlon 4 Ultra Herbicide

• Active Ingredient(s)
  • ETHYLENE
    • Guarantee/concentration .5 %
  • TRICLOPYR
    • Guarantee/concentration 60.5 %

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7. b) Type of formulation.

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).

Owner stated that the product was sprayed in his yard by a contract service. There was a strong odor of the product. The area where the cat liked to sit was treated as well.

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

Cat / Chat

3. Breed

Domestic Shorthair Cat

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

12

7. Weight (provide a range if necessary )

10.5

lbs

8. Route(s) of exposure

Unknown

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 - Anorexia

• Renal System
  • Symptom - Urinary incontinence

• Respiratory System
  • Symptom - Panting

• Cardiovascular System
  • Symptom - Other
  • Specify - Hypertrophic Cardiomyopathy

• Respiratory System
  • Symptom - Pulmonary edema

• General
  • Symptom - Death

12. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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?

Other / Autre

specify unknown

17. Provide any additional details about the incident

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

Owner noticed that the cat was not eating or drinking well. The cat was brought to Vet clinic on Dec 23 and the exam was normal. Owner stated that when the cat came in on Dec 26-27 he was panting. There was no improvement so the cat was brought back to Vet clinic. On Dec 27, lab work was normal except for the ECG. Cat was diagnosed with feline HCM. Antibiotics and heart medications were started. The cat continued to decline and was brought back to the Vet clinic on Jan 2. He was in very poor shape and had quite a bit of fluid in the lungs. The cat was subsequently euthanized.

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To be determined by Registrant

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

Death

19. Provide supplemental information here