Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-2337

2. Registrant Information.

Registrant Reference Number: SC2225717

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

Address: 215-2nd Street SW, Suite 2400

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.

30-APR-18

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

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.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Sonalan (non-specific)

• Active Ingredient(s)
  • ETHALFLURALIN
    • Unknown

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

Product Name: Reflex

• Active Ingredient(s)

---

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

Product Name: Warrent

• Active Ingredient(s)

---

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

Product Name: Thimet

• Active Ingredient(s)

---

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

Product Name: Valor

• Active Ingredient(s)

---

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

Product Name: Prowl

• Active Ingredient(s)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 62719-288

Product Name: Strongarm Herbicide

• Active Ingredient(s)

---

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: 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).

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.

Medical Professional

2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Cyanosis
  • Symptom - Pulmonary edema
  • Symptom - Shortness of breath

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?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Unknown

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

Application

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

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.

Skin

Respiratory

11. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

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.)

4/30/208 Caller is a physician treating a patient that potentially used this product and possibly up to six others over the last week. Patient's wife states that the patient refused to wear a mask while applying these products. The patient would come home covered in a yellow dust. Two days ago the patient came to the hospital significantly short of breath and hypoxic. His oxygen saturation was 92 percent and respiratory rate was 40 breaths per minute. His breathing declined and he was put on bilevel positive airway pressure, but breathing continued to decline. Patient was intubated and put on a ventilator, and given medication to help disperse fluid in the lungs. Oxygen saturation continued to slowly decline. Today the patient's heart rate and blood pressure are alright, but oxygen saturation is 52 percent. Many laboratory tests were performed including a chest x-ray. The chest x-ray showed bilateral diffuse airspace. A liver test was done this morning and was normal. 5/1/2018 The physician reports that the patient is not doing well, and his oxygen saturation is 77 percent on 100 percent fraction of inspired oxygen. A bronchoscopy has been completed, and was noted to have some sloughing in the upper airway. Chest x-rays have not shown improvement though they have diuresed about 8 to 9 liters of fluid. 5/2/2018 The physician reports that the latest chest x-ray did appear to be clearing a bit and his arterial blood gases looked a little better. They started the patient on stress dosed steroids and his oxygen saturation is 77 percent.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

The signs and symptoms reported in this case are not consistent with the known toxicology of the herbicides potentially involved in this exposure. Even had direct exposure occurred, such profound illness would not be expected. 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.