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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2018-0809
2. Registrant Information.
Registrant Reference Number: A170172189
Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.
Address: 2400, 215-2nd Street S.W.
City: Alberta
Prov / State: Calgary
Country: Canada
Postal Code: T2P 1M4
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
03-OCT-175. Location of incident.
Country: UNITED STATES
Prov / State: GEORGIA
6. Date incident was first observed.
01-AUG-17Product 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. Unknown
Product Name: Grazon
- Active Ingredient(s)
- PICLORAM (PRESENT AS ACID)
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: Field Pasture
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Pasture was treated 10 weeks prior to Oct. 3., 2017 with an unknown Grazon product. Animals had access 2 weeks post application. A donkey died on Sep. 12, 2017, followed by a gelding on Sep. 13, 2017, and then a mare on Oct. 3., 2017To 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 Donkey
3. Breed
Miniature Donkey
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
250
lbs
8. Route(s) of exposure
Oral
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
Pasture was treated 10 weeks prior to Oct. 3, 2017 with an unknown Grazon product. Animals had access 2 weeks post-application.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Because the time course was not consistent, the amount was unknown consistent, and the findings were not consistent, this substance was considered to have a not related likelihood of causing the clinical situation.
Subform III: Domestic Animal Incident Report
1. Source of Report
Medical Professional
2. Type of animal affected
Horse / Cheval
3. Breed
Paso Fino
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
15
7. Weight (provide a range if necessary )
1000
lbs
8. Route(s) of exposure
Oral
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.
Unknown
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
PaPasture was treated 10 weeks prior to Oct. 3, 2017 with an unknown Grazon product. Animals had access 2 weeks post-application.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Because the time course was not consistent, the amount was unknown consistent, and the findings were not consistent, this substance was considered to have a not related likelihood of causing the clinical situation.
Subform III: Domestic Animal Incident Report
1. Source of Report
Medical Professional
2. Type of animal affected
Horse / Cheval
3. Breed
Paso Fino
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
15
7. Weight (provide a range if necessary )
1200
lbs
8. Route(s) of exposure
Oral
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
Pasture was treated 10 weeks prior to Oct. 3, 2017 with an unknown Grazon product. Animals had access 2 weeks post-application.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Because the time course was not consistent, the amount was unknown consistent, and the findings were not consistent, this substance was considered to have a not related likelihood of causing the clinical situation.
