Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-4646

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

3. Select the appropriate subform(s) for the incident.


4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


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.


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

Product Name: Roundup

  • Active Ingredient(s)

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

Product Name: 2,4-D

  • Active Ingredient(s)
    • 2,4-D (PRESENT AS ACID)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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

Site: Agricultural-Outdoor/Agricole-extérieur

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

Caller is complaining of herbicide drift from neighbours property located at XXXXXX onto his ginseng plants. Not exactly sure when it happened but he thinks it was Wednesday of last week - has rained since then. Says the herbicide was put down because of the weeds in the neighbours field. believes the spray was applied Thurs June 26, observed the application when he was working in his own gardens. Didn't think it would be an issue, was not windy. Concerned now because some weeds in his garden are reacting and is worried that ginseng may have been damaged also.Spoke with worker in XXXXXX ginseng area, XXXXXX. Confirmed that he sprayed Roundup & 2,4-D about 2 weeks ago.

To be determined by Registrant

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


Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Herbaceous Plants / Plante herbacée

2. Common name(s)


3. Scientific name(s)


4. Number of organisms affected


5. Description of site where incident was observed

Fresh water



Salt Water

6. Check all symptoms that apply

Abnormal leaf discoloration

Abnormal plant stance

Epinasty (leaf wilt)

7. Describe symptoms and outcome (died, recovered, etc.).

Has taken some of the damaged plants, put them in a plastic bag and put in fridge.Cedar hedge 6m tall separates ginseng garden from soybean field at XXXXXX. No visible pesticide damage readily apparent on ginseng plants. , 3-5 acres, has ginseng 2nd yr and 3rd yr growth. Weeds in XXXXXX gardens that heven't been tilled are turning brown, twisted. Select weeds (lambs-quarters, fleabane) in east and north side of XXXXXX garden are twisted, distorted, but not turning brown. Ginseng in XXXXXX garden doesn't appear affected.Concerned now because some weeds in his garden are reacting and is worried that ginseng may have been damaged also. Visual symptoms (epinasty) consistent with 2,4-D. Suspect vapour drift from treated field may have affectedXXXXXX garden under little or no wind conditions. The ginseng plants did not show visual symptoms.

8. a) Was the incident a result of (select all that apply)


8. b) i) How many times has the product been applied this year?

8. b) ii) What was the date of the last application?

9. Did it rain

9. a) During application?


9. b) Up to 3 days after application?


10. a) Was there a buffer zone?


10. b) What type?

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?


To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here