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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-5120
2. Registrant Information.
Registrant Reference Number: Rocky Mountain Poison and Drug case #5660722
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.
11-AUG-165. Location of incident.
Country: CANADA
Prov / State: ALBERTA
6. Date incident was first observed.
24-JUL-16Product 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. 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)
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: Unknown / Inconnu
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Caller says that he used the Par III Turf Herbicide. It was used about 6 days. Used according to directions.To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
YesSubform III: Domestic Animal Incident Report
1. Source of Report
Medical Professional
2. Type of animal affected
Dog / Chien
3. Breed
mixed breed
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
14
7. Weight (provide a range if necessary )
100
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Foaming at mouth
- Specify - foaming at the mouth
- General
- Symptom - Other
- Specify - Epiphora
- Skin
- Symptom - Other
- Specify - Tatoo site purulent
- Gastrointestinal System
- Symptom - Drooling
- Specify - drooling at the mouth
- General
- Symptom - Vocalizing
- Specify - seem to be weeping
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
Owner saw the dog between 4am5amMST start to drool and foam at the mouth. She has been drooling since. Her eyes also seem to be weeping but they don't look irritated and she isn't squinting. The owner had applied this product to the yard 56 days ago and kept the dog off of it till it was dry. The owner thinks she may have licked or eaten some of the grass that had been previously sprayed. Owner also mentioned that the dog seemed a little disorientated. She does stumble a little but he doesn't know if its due to her age or not. No treatment has been done. (by (name) on Jul 24, 2016 at 10:55 AM)] Because the amount was poorly 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 lifethreatening.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
