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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-1592

2. Registrant Information.

Registrant Reference Number: SC2079017

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

Address: 2400, 215-2nd Street SW

City: Calgary

Prov / State: AB

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-JUL-17

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

Unknown

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. 14879      PMRA Submission No.       EPA Registration No.

Product Name: Lorsban 4E (Canada)

  • Active Ingredient(s)
    • CHLORPYRIFOS

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).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

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.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

  • Cardiovascular System
    • Symptom - Chest pain
  • Gastrointestinal System
    • Symptom - Irritated throat
  • General
    • Symptom - Pain
  • Nervous and Muscular Systems
    • Symptom - Headache
  • Respiratory System
    • Symptom - Coughing
    • Symptom - Shortness of breath
  • Nervous and Muscular Systems
    • Symptom - Aching

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

Unknown

7. Exposure scenario

Non-occupational

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

What was the activity? Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding the activity

Drift from the application site

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

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

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

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 h

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.)

Caller's wife was allegedly exposed to the product on 7/19/2017 when a crop duster plane was going overhead dripping product on the ground. She was outside for approx. one minute and could smell the product. Two hours later she developed chest tightness, difficulty breathing, worsening of an existing headache, throat irritation, neck pain, and body aches. She took Advil for her symptoms, but it did not help and symptoms persisted. On7/26/2017 caller's wife was seen by her primary doctor. An unspecified blood test was performed which did not reveal anything abnormal. No further tests or treatments were performed. Caller states that the treating doctor did not seem overly concerned with the potential exposure or with the patients symptoms. His wife has had somewhat of an intermediate cough, but it is improving. He notes that she was working in their garden earlier today and seems to be feeling better. The patient does not have any further medical follow-up appointments scheduled.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Direct exposure to this herbicide is not evident in this incident. The delayed onset of the patient symptoms hours after application is not suggestive of toxicity nor would they be expected symptoms should contact to airborne spray have occurred. Usually complications such as immediate onset of acute eye, skin and respiratory irritation may be seen following exposure to spray drift but these symptoms were not reported in this incident. The information contained in this report is based on self-reported statements provided to the registrant during telephone interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.