Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-5298

2. Registrant Information.

Registrant Reference Number: A140087948

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.

15-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)

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

Product Name: Arsenal Herbicide

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

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 62719-324

Product Name: Rodeo Herbicide

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
    • Guarantee/concentration 53.8 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 62719-519

Product Name: Milestone Specialty Herbicide

• Active Ingredient(s)
  • AMINOPYRALID
    • Guarantee/concentration 40.6 %

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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: Field/Pasture

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

Exposure involved unknown amount by unknown route. The exposure was yard use, occurred at animal owner field/pasture about 6 weeks ago. In the sprayed area, the owner had 2 riding horses, a dairy cow and 3 day old calf.

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

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

Unknown / Inconnu

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

17. Provide any additional details about the incident

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

Exposure involved unknown amount by unknown route. The exposure was yard use, occurred at animal owner field/pasture about 6 weeks ago. In the sprayed area, the owner had 2 riding horses, a dairy cow and 3 day old calf. Caller did not notice symptoms at all in the horses before they passed, does not look at them every single day. Owner is looking to see if any of these products would be related.

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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

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Cow / Vache

3. Breed

Dairy Cow

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

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

• General
  • Symptom - Other
  • Specify - unspecified sickness

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

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

Exposure involved unknown amount by unknown route. The exposure was yard use, occurred at animal owner field/pasture about 6 weeks ago. In the sprayed area, the owner had 2 riding horses, a dairy cow and 3 day old calf. Owner is looking to see if any of these products would be related. The Dairy cow was sick before she was shipped.

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To be determined by Registrant

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

Minor

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Cow / Vache

3. Breed

3 day old calf

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0

7. Weight (provide a range if necessary )

Unknown

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

• Skin
  • Symptom - Hair loss
  • Specify - Loss of all it's hair

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

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

Exposure involved unknown amount by unknown route. The exposure was yard use, occurred at animal owner field/pasture about 6 weeks ago. In the sprayed area, the owner had 2 riding horses, a dairy cow and 3 day old calf. Owner is looking to see if any of these products would be related. The 3 day old calf was losing it's hair.

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To be determined by Registrant

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

Minor

19. Provide supplemental information here