Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-1301

2. Registrant Information.

Registrant Reference Number: 2009-IR-01

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.

16-APR-09

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

30-MAR-09

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: Vydate Insecticide

• Active Ingredient(s)
  • OXAMYL
    • Unknown

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7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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

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

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

Dog / Chien

3. Breed

Blue heeler, and second dog was Australian seep, third unknown

4. Number of animals affected

3

5. Sex

Male

Female

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

lbs

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Drooling
  • Symptom - Vomiting

• Nervous and Muscular Systems
  • Symptom - Confusion

• Respiratory System
  • Symptom - Respiratory failure
  • Specify - Respiratory Arrest

• 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?

Other / Autre

specify unknown exposure - Non-Occupational

17. Provide any additional details about the incident

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

The callers dogs were outside for approximately 30 minutes and female came in ill. She was taken to the vet. Male developed symptoms soon after.

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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

Vet heard of a dog that had recently died, with similar symptoms, while under the care of another vet. The dog that died , is the neighbor's dog and was exposed to Vydate. Unknown any details of the exposure, Unknown Vydate product, owner has not seen the container. Unknown if its a granular or liquid product. Neighbor's dog died, owners dogs had moderate symptoms. Unknown duration and outcome.