Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2017-5200
2. Registrant Information.
Registrant Reference Number: ProPharma Group case#: 1-49223492
Registrant Name (Full Legal Name no abbreviations): FMC Corporation
Address: 2929 Walnut Street
City: Philadelphia
Prov / State: Pennsylvania
Country: USA
Postal Code: 19104
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
03-AUG-17
5. Location of incident.
Country: UNITED STATES
Prov / State: NEBRASKA
6. Date incident was first observed.
22-JUL-17
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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 279-3313
Product Name: BRIGADE 2EC INSECTICIDE/MITICIDE
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 66330-223
Product Name: DIMETHOATE 4E
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: 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).
1-49223492 - A non-company product Dimethoate 4E (EPA Reg: 66330-223) was mixed with the Brigade 2 EC insecticide/miticide in the aerial sprayer.
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
Labrador Retriever
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
1.5
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
- Nervous and Muscular Systems
12. How long did the symptoms last?
Persisted until death
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
1-49223492 - The reporter, a pest control officer, indicates an exposure to a pesticide with the active ingredient bifenthrin. Twelve days before the day of initial contact with the registrant, the reporter indicated a 1.5-year-old, male, Labrador Retriever dog of unknown weight had collapsed and died an unknown amount of time after being exposed to drift from an aerial spraying of the diluted product. The reporter indicated the dog died before he could be brought to a veterinarian. No additional information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here