Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-5117

2. Registrant Information.

Registrant Reference Number: 2008-IR-07

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.

15-SEP-08

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

05-SEP-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. 352645

Product Name: Landmark XP Herbicide

• Active Ingredient(s)
  • CHLORSULFURON
  • SULFOMETURON 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: Industrial / Industriel

Préciser le type: poles

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

Not sure - product was applied to poles outside. It was applied with a handheld Herbi sprayer. It sounds like it was spot treatment.

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

Other

2. Type of animal affected

Bird / Oiseau

3. Breed

Parakeet and minature parrot

4. Number of animals affected

2

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Respiratory

9. What was the length of exposure?

>8 hrs <= 24 hrs / >8 h <= 24 h

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• General
  • Symptom - Death
  • Specify - 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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

Owner of the birds complained about the spraying, and pulled off the MSDS and labels from the internet. They did not take the birds to the vet because the birds were already buried. We did not find out what exactly killed the birds.

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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