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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2021-3940
2. Registrant Information.
Registrant Reference Number: CTVA2392021
Registrant Name (Full Legal Name no abbreviations): Corteva Agriscience Canada Company
Address: Suite 2450, 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.
11-JAN-21
5. Location of incident.
Country: UNITED STATES
Prov / State: ILLINOIS
6. Date incident was first observed.
07-JUL-20
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. 28517
PMRA Submission No.
EPA Registration No. 62719-519
Product Name: Milestone
- Active Ingredient(s)
- AMINOPYRALID, PRESENT AS TRIISOPROPANOLAMINE SALT
- Guarantee/concentration 240 g/L
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: Unknown / Inconnu
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Property owner claims goats came into contact with treated area.
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
Other
2. Type of animal affected
Other / Autre
specify Goat
3. Breed
Unknown
4. Number of animals affected
2
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
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
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Died
16. How was the animal exposed?
Other / Autre
specify Exposure is unknown
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Property owner claims goats came into contact with treated
area.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here