Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2810

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: xx

City: x

Prov / State: x

Country: x

Postal Code: X

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

Domestic Animal

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

13-AUG-13

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. 27294      PMRA Submission No.       EPA Registration No.

Product Name: Indor 75 WSP

• Active Ingredient(s)
  • FENBUCONAZOLE

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PMRA Registration No. 30163      PMRA Submission No.       EPA Registration No.

Product Name: Topas 250 EC

• Active Ingredient(s)
  • PROPICONAZOLE

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PMRA Registration No. 19531      PMRA Submission No.       EPA Registration No.

Product Name: Sevin Liquid XLR

• Active Ingredient(s)
  • CARBARYL

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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: cherries and apricots

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

Caller states that the closest row of cherry trees is 6 feet from the fence, the wheels of the sprayer are almost touching the fence when he sprays, there are no setbacks marked out prior to spraying. Caller states that there is approximately 150ft of fence along the property line.

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

Other

2. Type of animal affected

Dog / Chien

3. Breed

4. Number of animals affected

1

5. Sex

Male

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 - tumours on feet

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

Caller states that her next door neighbour has 2 acres and approximately 100 fruit trees. The neighbour has her trees sprayed and the spray always comes over onto their property through the fence and over the fence in a big cloud. Caller states that they have their backyard fenced in. Their dogs run along the fenceline and she has grandchildren who play outside. Caller also has an organic vegetable garden. Caller went out to speak with the person who does the spraying on July 13, and asked him to tell the property owner that they would like the row of trees closest to the property line to be hand sprayed to eliminate the impacts to her property. The person spraying told her that he is a licensed sprayer for pesticides and that pesticides are not harmful. Caller and her husband also wrote a letter to the property owner requesting her to hand spray the row of trees along the property line and to provide a list of the chemicals that are sprayed on the trees. Caller states that her dog has tumours on his feet, the vet has told her that the tumours are a result of environmental contact. Caller states that the tumours became an issue in 2011, which is when they put their fence in. The dogs were walked by leash prior to the fence going in. When the dogs were walked by leash, they were walked on the other side of the caller's property and there were never any health issues. Now, the dogs run along the fence, and it is the caller's belief that the chemicals in the spray have resulted in the impacts to the dogs paws. Caller tried to speak to the property owner about spraying the trees along the property line by hand this past Friday, the property owner told her that she had no rights and that she would just have to live with it. Caller wants to know if the property owner is doing something wrong, caller wants the property owner to be required to handspray the row closest to the property line and wants a list of chemicals in the spray so that she can take it to her vet to find out if one of them could have caused the tumours in her dogs paws.

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To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here