Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2967

2. Registrant Information.

Registrant Reference Number: 330841

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

Address: 450-1st Street S.W., Suite 2100

City: Calgary

Prov / State: AB

Country: Canada

Postal Code: T2P 5H1

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

Human

4. Date registrant was first informed of the incident.

11-JUN-08

5. Location of incident.

Country: UNITED STATES

Prov / State: ARIZONA

6. Date incident was first observed.

11-JUN-97

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.

Product Name: Dursban (registration unknown)

• Active Ingredient(s)
  • CHLORPYRIFOS
    • Unknown

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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. - In Home / Rés. - à l'int. 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?

Yes

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: Female

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Blood
  • Symptom - Anemia

• Cardiovascular System
  • Symptom - Other
  • Specify - Unspecified heart condition

• General
  • Symptom - Edema
  • Symptom - Joint pain

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

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.

Unknown

11. What was the length of exposure?

<=15 min / <=15 min

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.)

6/11/08 Caller states product was applied subterraneously in 1997 in her home for termites. The caller states she immediately developed swelling of both wrists. She was seen by a homeopathic doctor who told her she had pesticide poisoning shortly after the application of the product in her home. The caller states she also found she was anemic and was diagnosed with an unspecified heart condition (unknown). Caller states her homeopathic doctor told her that her arthritis was due to the pesticide poisoning and it is now in her bones. The caller states there was no known direct exposure to the pesticide especially since it was applied subterraneously .

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

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. The possibility of this patient¿s ongoing illness being linked to her simply reentering a home 11 years ago following the subterranean termite application is simply inconceivable based on the weight of existing peer reviewed scientific data.