Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-6193

2. Registrant Information.

Registrant Name (Full Legal Name no abbreviations): E. I. du Pont Canada Company

Address: P.O. Box 2300, Streetsville

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5M 2J4

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

Human

4. Date registrant was first informed of the incident.

30-AUG-07

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

22-AUG-07

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 352616

Product Name: Cimarron Herbicide

• Active Ingredient(s)
  • METSULFURON-METHYL
    • Guarantee/concentration 60 %

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

Product Name: round-up

• Active Ingredient(s)
  • GLYPHOSATE
    • Guarantee/concentration 360 g/L

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7. b) Type of formulation.

Liquid

Dry Flowable (water dispersible granules)

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Other / Autre

Préciser le type: cemetery

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

Product was applied yearly, for a couple of hours. He also applies "round-up" a couple of times a year. Following product use, (name) was asymptomatic. He had sprayed a couple of hours with product. He felt mist on his back, face and arms; he felt sticky from surfactant. Got clothes off and bathed thoroughly.

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: Male

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

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Fasciculations

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?

7. Exposure scenario

Unknown

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

Application

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

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

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.)

acThe following are allegations communicated to DuPont: (name) states that he was diagnosed with myopathy - muscular fasciculation syndrome this year. He was using Dupont herbicide product yesterday and began wondering if maybe this chronic condition could be related to his application of herbicide at a cemetery once yearly, applies product for a couple of hours. He states that he also applies "Round Up" product a couple of times a year, no more on this. Following product use on July 21, 2007, (name) was asymptomatic. He had sprayed a couple of hours with product yesterday. He felt mist on his back, face and arms; he felt sticky from surfactant. Got clothes off and bathed thoroughly.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Male- diagnosed with myopathy - muscular fasciculation syndrome. Currently asymptomatic patient with questions about cause of his medical condition, could herbicide be related? Because of the length of the claim, we believe this falls under a human-major/moderate, but we are not certain since this is strictly allegations.