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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-5792

2. Registrant Information.

Registrant Reference Number: 2017-22

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

Address: 100 Milverton

City: Mississauga

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.

12-SEP-17

5. Location of incident.

Country: UNITED STATES

Prov / State: MICHIGAN

6. Date incident was first observed.

04-AUG-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. 241-379

Product Name: Raptor

  • Active Ingredient(s)
    • IMAZAMOX
      • Guarantee/concentration 12.1 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 7969-45-1381

Product Name: Basagran

  • Active Ingredient(s)
    • BENTAZON
      • Guarantee/concentration 44 %

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

Product Name: Reflex (ICI America)

  • Active Ingredient(s)
    • FOMESAFEN

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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: bean

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

Products applied to neighbor bean field, claim drifted to alfalfa field

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

Animal's Owner

2. Type of animal affected

Cow / Vache

3. Breed

holstein

4. Number of animals affected

6

5. Sex

Female

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Trembling
  • General
    • Symptom - Death

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

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

2 cows died, one aborted, 3 were sick but were culled. Spray Aug 4, lethargy aug 9, deaths aug 9 and 18, abortion aug 18. The cows that died had symptoms of milk fever a few days prior.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

Doubtful likelihood