Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2018-1495
2. Registrant Information.
Registrant Reference Number: 2018-2
Registrant Name (Full Legal Name no abbreviations): BASF Canada
Address: 100 Milverton
City: Mississauaga
Prov / State: ON
Country: Canada
Postal Code: L5R 4H1
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
06-APR-18
5. Location of incident.
Country: UNITED STATES
Prov / State: ARIZONA
6. Date incident was first observed.
04-APR-18
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. 241-341
Product Name: Pendulum 3.3 industrial herbicide
- Active Ingredient(s)
- PENDIMETHALIN
- Guarantee/concentration 37.4 %
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: Res. - Out Home / Rés - à l'ext.maison
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Owner had herbicide sprayed in yard and waited until dry to let dog out
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
Dog / Chien
3. Breed
golden retriever
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
7
7. Weight (provide a range if necessary )
85
lbs
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
- Gastrointestinal System
- Symptom - Foaming at mouth
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?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Dog not allowed in yard until herbicide dried. Next evening dog outside convulsing and foaming at mouth, dog died on way to vet:
seizure April 4th at 9:45, death at 10:40
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Not consistent with known toxicity (GI); Not Related Likelihood.