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
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