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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-1315
2. Registrant Information.
Registrant Reference Number: A150156486
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.
12-NOV-155. Location of incident.
Country: UNITED STATES
Prov / State: IOWA
6. Date incident was first observed.
07-NOV-15Product 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)PMRA Registration No. PMRA Submission No. EPA Registration No. 62719-527
Product Name: Garlon 4 Ultra Herbicide
- Active Ingredient(s)
- TRICLOPYR, PRESENT AS BUTOXYETHYL ESTER
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: Res. - Out Home / Rés - à l'ext.maison
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
The alleged exposure occurred at animal owner yard on September 11, 2014. There were 10 small trees that were spot sprayed with the product. In November, 2014, the owner's dog died. By spring, 2015, several months later, a total of 32 deer had died.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
Other / Autre
specify Deer
3. Breed
Unknown
4. Number of animals affected
32
5. Sex
Unknown
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 - 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
Because the amount was unknown consistent, the patient was considered to be at very low risk of developing clinical signs. If signs had developed, there is very low risk that those signs would have been be life threatening. Would not expect death from this type of herbicide product. The time frame also does not fit with potential exposure outside the enclosure.
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
Dog / Chien
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
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?
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 alleged exposure occurred at animal owner yard on September 11, 2014. There were 10 small trees that were spot sprayed with the product. In November, 2014, the owner's dog died. By spring, 2015, several months later, a total of 32 deer had died.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
