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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-1159

2. Registrant Information.

Registrant Reference Number: 190097599

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

Address: Suite 2400, 215 - 2nd Street S.W.

City: Calgary

Prov / State: Alberta

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.

06-JUN-19

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

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. 20331      PMRA Submission No.       EPA Registration No.

Product Name: MCPA DEA 600 Herbicide Concentrate

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

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Rotweiller

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.5

7. Weight (provide a range if necessary )

22.3

kg

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
    • Symptom - Trembling
  • Skin
    • Symptom - Hyperesthesia
  • Gastrointestinal System
    • Symptom - Vomiting
  • Renal System
    • Symptom - Low urine output
  • Nervous and Muscular Systems
    • Symptom - Collapse
  • General
    • Symptom - Fever
    • Symptom - Hyperthermia
    • Symptom - Pain

12. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

2

Day(s) / Jour(s)

15. Outcome of the incident

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Other / Autre

specify Unknown exposure

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

The dog presented to the vet with symptoms. Upon treatment, the dog improved. Clinical signs are not consistent with these products. The dog had access to an acreage that is surrounded by nurseries and there is water runoff from those onto the property


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Moderate

19. Provide supplemental information here

Clinical signs were not consistent with these products specifically. May be more in line with moldy food/compost, mushrooms, a slug bait, or bromethalin bait.