Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2605

2. Registrant Information.

Registrant Reference Number: Rocky Mountain Poison and Drug case #5468928

Registrant Name (Full Legal Name no abbreviations): LOVELAND Products Canada, Inc.

Address: 789 Donnybrook Drive

City: Dorchester

Prov / State: Ontario

Country: Canada

Postal Code: N0L1G5

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

Domestic Animal

4. Date registrant was first informed of the incident.

22-JUN-15

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

17-JUN-15

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. 27884      PMRA Submission No.       EPA Registration No.

Product Name: PAR III TURF HERBICIDE

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
  • MECOPROP-P (PRESENT AS DIMETHYLAMINE SALT)

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: GRASS

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

(name) 06/17/15 10:49 S: Caller is calling about the Par 3 Herbicide She spoke to the person/phone number on the package. She was sent to an incident response center. She was then sent somewhere else. Given a Customer service number. Called them. Gave her a name Scott who sent her around to another number. And then finally to us. She is calling to find out if this product killed their sheep. Sprayed according to the package Weeds cut down prior to spraying. Sheep were allowed to graze and died. What they want to know is, it says that it is safe with children and animals. They are looking for a reassurance that the Par 3 is not what cause the problem This was in the last week. Not 100% sure on when sheep grazed Thinks within 48 hours of the field being treated. The package said 24 hours would be ok O: sheep died. A: Sheep acute ingestion of grass that had been exposed to the Par III Herbicide. Per Agrium Retail Guidelines for Animal Exposure. Warm Transfer to the NAPCC R: Provided case number to caller. Will transfer to the NAPCC Provided information to (first name) she is going to get her vet to handle this case. Dr (name) # Warm conferenced. Call prn bjb

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

Sheep / Mouton

3. Breed

unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

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

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

Patient 1 Information Patient Name: Gender: Unknown Receptor: Animal Address: Age: unknown age Weight: Not Specified City, State, Zip, Cntry: USA Phone: Species: Sheep Breed: Patient 1 Exposure Information Exposure Site: Workplace Reason Detail: Adverse Reaction Chemical AROAdverse Reaction Other Occupational: No Acuity: Unknown Product Name: Par III Turf Herbicide Time Of Exposure: Unknown Route: Ingestion Amount Of Exposure: unknown Certainty: estimate Duration: Patient 1 Clinical Effects Effects Present: Cardiovascular Asystole Relatedness: Unknown if related Onset: Unknown Patient 1 Management Information Type: Veterinary Services Result: Callback not necessary SubType: Transferred to NAPCC Patient 1 Therapy Information Patient 1 Outcome Medical Outcome: Death Effect Duration: Industry Outcome: Death Industry Duration: Unknown Causation: Unknown if Related EPA Code: DA

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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

Please find included in submission, the case information form from Rocky Mountain Poison and Drug Center.