Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4046

2. Registrant Information.

Registrant Reference Number: 2008-IR-09

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

Address: P.O. box 2300, Streetsville

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5M 2J4

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

Domestic Animal

4. Date registrant was first informed of the incident.

21-SEP-08

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

06-MAY-05

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: Krenite S EPA # 352-395 and DuPont Escort XP EPA# 352-439

• Active Ingredient(s)
  • FOSAMINE AMMONIUM
    • Guarantee/concentration 4
  • METSULFURON-METHYL
    • Guarantee/concentration 60 %

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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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: right-of-way

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

Product was applied using back pack sprayers. It appeared to be applied by unlicensed workers.

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

Animal's Owner

2. Type of animal affected

Horse / Cheval

3. Breed

unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

18

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

9. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

10. Time between exposure and onset of symptoms

>6 mos / > 6 mois

11. List all symptoms

System

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Not recovered / Non rétabli

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

Product appeared to be sprayed onto homeowners land without authorization. Spot treatment mostly beside the right-of-way. Along with foliage dying and other brush species such as blueberry bushes, etc, their horses were able to graze the affected pasture for 5 days following the application. Approximately 2 years after the application of said herbicide, the 18 year old horse died. Veterinarians said with unknown cause.

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To be determined by Registrant

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

Death

19. Provide supplemental information here