Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-4403

2. Registrant Information.

Registrant Reference Number: A150080757

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.

17-JUN-15

5. Location of incident.

Country: UNITED STATES

Prov / State: SOUTH DAKOTA

6. Date incident was first observed.

13-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.       PMRA Submission No.       EPA Registration No. 62719-597

Product Name: Chaparral Specialty Herbicide

• Active Ingredient(s)
  • AMINOPYRALID (PRESENT AS POTASSIUM SALT)
    • Guarantee/concentration 62.13
  • KAOLIN
    • Guarantee/concentration 2.7
  • METSULFURON-METHYL
    • Guarantee/concentration 9.45
  • TITANIUM DIOXIDE
    • Guarantee/concentration .1

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: 2,4-D (not specified agent id)

• Active Ingredient(s)
  • 2,4-D (PRESENT AS ACID)
    • Unknown

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7. b) Type of formulation.

Other (specify)

Concentrate

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: unknown

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

Owner applied the product on his pasture 6/13 and 6/14 in the afternoon.

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

Horse / Cheval

3. Breed

Quarter Horse (Equine)

4. Number of animals affected

1

5. Sex

Male

Female

6. Age (provide a range if necessary )

13

7. Weight (provide a range if necessary )

1200

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

• General
  • Symptom - Death

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

No

14. a) Was the animal hospitalized?

No

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 was found dead on June 16th. Owner stated he applied the product per label instructions. This horse was in the pasture with 3 others and her 2 week old colt. Owner is wondering if the product could react with a plant to cause toxicity.

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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

Unlikely that grazing in pasture with properly applied herbicide would cause illness, let alone sudden death - especially with 3 still healthy horses and this mare's 2 week old foal in same enclosure. Because the amount was unknown consistent, the patient was considered to be at low risk of developing clinical signs. If signs develop, there is low risk that those signs will be life-threatening. Unless horse was grazing newly treated toxic plants, this product is unlikely involved.