Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3709

2. Registrant Information.

Registrant Reference Number: 2009-IR-05

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

Address: 7070 Mississauga Road

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5N 5M8

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

Human

4. Date registrant was first informed of the incident.

28-AUG-09

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

Unknown

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. unknown

Product Name: Benlate

• Active Ingredient(s)
  • ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
    • Unknown
  • BENOMYL

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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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: "farm" -use site not known

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

In a complaint filed with the (name) Circuit Court, (state)(case # ), the plaintiff, (name) states that he used Benlate fungicide on his farm while farming in 1990-1991, and alleges that Benlate was contaminated with atrazine, No information is provided on how exposure may have occurred or the extent to which it may have occurred. (name), in the complaint, is alleging that the contact with Benlate contaminated with atrazine has resulted in his contracting "kidney and brain" cancer.

To be determined by Registrant

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

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Cancer
  • Specify - Brain cancer
  • Symptom - Cancer
  • Specify - Kidney cancer

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

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?

Unknown / Inconnu

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.)

Patient was diagnosed with cancer of the brain and kidney

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

No information is provided on how exposure may have occurred, or the extent to which exposure may have occurred, or type and duration of symptoms that may have resulted to(name)In the complaint, it is alleged that contact with the atrazine contaminant in Benlate has resulted in his contracting "kidney and brain" cancer. He has experienced "severe bodily injury, pain, and suffering, hospitalization, medical expenses in the past, present, and future".