Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-5297

2. Registrant Information.

Registrant Reference Number: A140109650

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.

29-AUG-14

5. Location of incident.

Country: UNITED STATES

Prov / State: KANSAS

6. Date incident was first observed.

29-AUG-14

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. 62719-182

Product Name: Grazon P + D Range and Pasture Management

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
    • Guarantee/concentration 39.6 %
  • PICLORAM (PRESENT AS AMINE SALTS)
    • Guarantee/concentration 10.2 %

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Other / Autre

Préciser le type: Pasture

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

Horse got into pasture that was sprayed the morning of Aug 29, 2014.

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

Medical Professional

2. Type of animal affected

Horse / Cheval

3. Breed

Equine Unspecified

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

24

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Respiratory System
  • Symptom - Other
  • Specify - Stridor

• General
  • Symptom - Lethargy

• Respiratory System
  • Symptom - Runny nose
  • Specify - Nasal discharge

• General
  • Symptom - Death

• Respiratory System
  • Symptom - Choking

12. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 h

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

The horse, which was previously in good health, got into a pasture that had been sprayed the same morning. Horse was not doing well and was taken to a vet. The vet found that the horse had actually choked on grain. They started the horse on medications. The horse went back home and stayed in a stall. It was drinking well and eating okay but not 100% healthy. The caller was not sure what medications the horse was on except for Unipram. The horse died 2 days later. Owner thinks it was just old age and stress from the choking that caused his death, not the product.

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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

Because the time course was not consistent, the amount was unknown consistent, and the findings were not consistent, the substance was considered to have not been related to the cause of the clinical situation.