Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-3012

2. Registrant Information.

Registrant Reference Number: 2016-4

Registrant Name (Full Legal Name no abbreviations): BASF Canada

Address: 10 Milverton, 5th floor

City: Mississauag

Prov / State: ON

Country: Canada

Postal Code: L5R4H1

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

Domestic Animal

4. Date registrant was first informed of the incident.

24-MAY-16

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

19-MAY-16

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. 23713      PMRA Submission No.       EPA Registration No.

Product Name: Arsenal hericide

• Active Ingredient(s)
  • IMAZAPYR

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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: Industrial / Industriel

Préciser le type: field

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

Applied by oil worker to field on May 17,2016 according to label. Area treated approx 50 sq yds, at least 40feet (or yards) from fence of pasture where horses later were. No horses observed during application. Wind direction was away from pasture, towards field.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Horse / Cheval

3. Breed

Unknown

4. Number of animals affected

3

5. Sex

Male

Female

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?

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

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Diarrhea
  • Symptom - Bloody diarrhea

• General
  • Symptom - Death
  • Symptom - Lethargy

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?

Spray drift / Dérive de pulvérisation

17. Provide any additional details about the incident

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

On May 19 male foal (age 3-4 weeks) was found dead in pasture adjacent to field which had a portion treated 2 days earlier with Arsenal. A second foal died May 20, sfter experiencing dehydration, diarhea and lethargy May 19. Pregnant mare had bleeding/vulvar hemorage May 19, appeared to mostly recover later.

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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

Symptoms inconsistent with Arsenal. potentially minor/any exposure situation documented.