Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5165

2. Registrant Information.

Registrant Reference Number: 2009-IR-10

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.


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: CALIFORNIA

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 1812-257

Product Name: Griffin DIrex-4L herbicide

  • Active Ingredient(s)
    • DIURON
      • Guarantee/concentration 4

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 352-401; 352-601

Product Name: Dupont Oust Herbicide

  • Active Ingredient(s)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 342-404

Product Name: Dupont Telar Herbicide

  • Active Ingredient(s)

7. b) Type of formulation.


Dry Flowable (water dispersible granules)

Application Information

8. Product was applied?


9. Application Rate.


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

Site: Industrial / Industriel

Préciser le type: highway right-of-way

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

The complainant, Mr. (name), is/was a pesticide applicator.

To be determined by Registrant

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


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

1. Source of Report.


2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.


  • Respiratory System
    • Symptom - Asthma
  • Gastrointestinal System
    • Symptom - Stomach pain

4. How long did the symptoms last?

>6 mos / > 6 mois

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


8. How did exposure occur? (Select all that apply)


Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


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.)

On 18 September, 2009, Mr. (name) of (city, state) filed a complaint (#) with the Superior Court of (state) County of (city) in which he alleged symptoms as described in this report resulted from exposure to Griffin Direx(diuron), Oust(sulfometuron methyl) and Telar(chlorsulfuron) during his employment as a pesticide applicator. In the complaint, it was stated "...the company knew the damage that these pesticides caused, yet did nothing to avoid the exposure of them. I used the products in the manner intended by the defendant, but still damage resulting from the use of these products. Because of the company's choice, they took away my opportunity to live a normal life. I now have a of physical problems that have been diagnosed throughout the last couple of years. These problems began within the statute of limitations of two years. And it is known that more problems could possibly happen in the next few years. At this moment, I cannot complain to these new problems , since I do not know whether more will possibly occur.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

Previously, on 29 November, 2006, E.I. du Pont de Nemours and Company had submitted an individual report (Dupont ID #) to the EPA for an alleged incident regarding exposure of Mr. (name) to Griffin Direx herbicide, EPA reg. No. 1812-257, Monsanto Round Up Pro Concentrate Herbicide, EPA Reg No. 524-529, and Syngenta Reward Landscape and Aquatic Herbicide, EPA Reg. No. 100-1091. In this report, Mr. (name) alleged multiple symptoms including abdominal pain, diarrhea, asthma, weakness, losing sense of smell, and also reported that "MD states there is a problem with the liver". On 11 September 2008, Mr. (name) filed a complaint (#) with The superior Court of (state) County of (city), in which he alleged symptoms including those reported to the EPA in Dupont ID # as a result of exposure to Griffin Direx 4L EPA Reg No. 1812-257, as well as other unspecified pesticide products.