Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-1590

2. Registrant Information.

Registrant Reference Number: CHEM170518-00110

Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.

Address: Suite 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.

Human

4. Date registrant was first informed of the incident.

21-JUN-17

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

17-MAY-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)

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PMRA Registration No. 30914      PMRA Submission No.       EPA Registration No.

Product Name: Curtail M Herbicide

• Active Ingredient(s)
  • CLOPYRALID
  • MCPA (PRESENT AS ESTERS)

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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: unknown

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

Exposure to the pesticide was accidental. The grower was cleaning the sprayer nozzle and the nozzle exploded.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Vomiting

4. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

5. Was medical treatment provided? Provide details in question 13.

Yes

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Poisoning from ingestion of the pesticide

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Goggles

10. Route(s) of exposure.

Oral

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

Exposure to the pesticide was accidental. The grower was cleaning the sprayer nozzle and the nozzle exploded. He was wearing glasses, so there was no eye exposure, but a small amount of pesticide (a few mL) accidentally was ingested. He had symptoms of vomiting for a day and was asked to keep hydrating by a nurse. He was feeling better by the next day.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.