Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-5299

2. Registrant Information.

Registrant Reference Number: A140084379

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.

08-JUL-14

5. Location of incident.

Country: UNITED STATES

Prov / State: UNKNOWN

6. Date incident was first observed.

27-JUN-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. 62719-519

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).

The exposure was yard use, and occurred at animal owner field/pasture. Product was sprayed on 06/27/14 where the horse had access.

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

Arabian Horse

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

10

7. Weight (provide a range if necessary )

1000

lbs

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

• Renal System
  • Symptom - Renal failure

• Cardiovascular System
  • Symptom - Tachycardia
  • Specify - Heart rate at 90 bpm

• General
  • Symptom - Adipsia
  • Specify - Lack of thirst

• Skin
  • Symptom - Edema
  • Specify - Edema of the legs

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.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Euthanised / Euthanasie

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

Horse was in good health previously. The exposure was yard use, and occurred at animal owner field/pasture. 07/04/14 is when the horse started showing symptoms with lack of thirst. After a long walk, horse was then tied up and they could not lower the heart rate below 90 bpm. Owner mentioned a variety of symptoms including renal failure and edema of the legs. Horse was euthanized because he was not getting any better. Owner wanted to see if this could 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

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.