Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4047

2. Registrant Information.

Registrant Reference Number: 2008-IR-08

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.

01-OCT-08

5. Location of incident.

Country: UNITED STATES

Prov / State: OHIO

6. Date incident was first observed.

04-AUG-08

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: Synchrony XP EPA # 352-650

• Active Ingredient(s)
  • CHLORIMURON-ETHYL
    • Unknown
  • THIFENSULFURON METHYL
    • Unknown

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7. b) Type of formulation.

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: soybean field

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

Ingestion was claimed by owner of animal. Herbicides were sprayed up to the property owners fence by farmers request (soybean field was sprayed). Spray was confined within the fields parameters. Synchrony XP was applied at 0.33 oz/ac tankmixed with Roundup at 32 oz/ac by a broadcast post application to the crop. No tests were conducted. The donkey had died.

To be determined by Registrant

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

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Other / Autre

specify donkey

3. Breed

donkey

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

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.

Unknown

14. a) Was the animal hospitalized?

Unknown

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

Customer applied product to farmers soybean field. Applicator was asked, by the farmer, to spray right up to the fence line. The owner of the donkey presumed that the animal ingested the herbicides applied near the fence row and later died. The owner of the donkey did say that the fence was designed to keep in their horses and the donkey was not contained at all time within the pasture perimeters. The donkey, being significantly shorter than the horses, had free rein to roam where ever it chose.

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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