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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3782

2. Registrant Information.

Registrant Reference Number: 2009-IR-06

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.

Domestic Animal

4. Date registrant was first informed of the incident.

14-SEP-09

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

30-JUL-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)

PMRA Registration No. 27348      PMRA Submission No.       EPA Registration No.

Product Name: Kocide 2000

  • Active Ingredient(s)
    • COPPER AS ELEMENTAL (PRESENT AS COPPER HYDROXIDE)

PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: Manzate

  • Active Ingredient(s)
    • MANCOZEB

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: unknown

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

Product(s) were applied to a field adjacent to the property where the animal lived. Application method, use rates not known

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

Other

2. Type of animal affected

Dog / Chien

3. Breed

Great Dane

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1.5

7. Weight (provide a range if necessary )

160

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Seizure

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

specify method of exposure unknown - may have been spray drift or overspray of dog's yard.

17. Provide any additional details about the incident

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

Incident occurred in (location) and local veterinarian contacted (name) Poison and Drug Centre, (city, state) (case # ). Field adjacent to dog yard was sprayed on July 29, Aug 19 and Aug 25. Dog had moderate seizures on July 30, Aug 20 and Aug 30. "Because the time course was not consistent , the amount was unknown consistent, and the findings were not consistent, this substance was considered to have not related liklihood of causing the clinical situation". Epilepsy was considered to have "medium liklihood of causing the clinical situation." Symptomatic treatment was recommended.


To be determined by Registrant

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

Minor

19. Provide supplemental information here