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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-2757

2. Registrant Information.

Registrant Reference Number: 2014-25

Registrant Name (Full Legal Name no abbreviations): BASF Canada

Address: 100 Milverton, 5th floor

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5R4H1

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

Domestic Animal

4. Date registrant was first informed of the incident.

05-JUL-14

5. Location of incident.

Country: UNITED STATES

Prov / State: PENNSYLVANIA

6. Date incident was first observed.

Unknown

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. 23713      PMRA Submission No.       EPA Registration No. 241-346

Product Name: Arsenal

  • Active Ingredient(s)
    • IMAZAPYR
      • Guarantee/concentration 28.7 %

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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

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

unknwn

4. Number of animals affected

2

5. Sex

Unknown

6. Age (provide a range if necessary )

11

7. Weight (provide a range if necessary )

900

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>1 mo <=2 mos / > 1 mois < = 2 mois

11. List all symptoms

System

  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Died

16. How was the animal exposed?

Other / Autre

specify unknown, as a pasture was sprayed with 3 products 6 weeks ago

17. Provide any additional details about the incident

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

fiels/pasture sprayed with ARSENAL,RODEO and MILESTONE approx 6 weeks ago. Area had 2 horses, dairy cow and 3d old calf. DC was sick, 3d old calf losing all of hair. No symptoms noticed in horses.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Doubtful likelihood