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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5087

2. Registrant Information.

Registrant Reference Number: 2010-IR-04

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: LN 5M8

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

Domestic Animal

4. Date registrant was first informed of the incident.

12-OCT-10

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

09-SEP-10

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 Fungicide

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

7. b) Type of formulation.

Application Information

8. Product was applied?

No

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

Labrador Retreiver

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

65

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting

12. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Fully Recovered / Complètement 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

The dog punctured the bag and ingested up to a tbsp of the agent. (by IM on Sep 09, 2010 at 12:49 PM)] Because the amount was generally consistent, the patient was considered to be at high risk of developing clinical signs. If signs develop, there is low risk that those signs will be lifethreatening. [Note : GI and oral irritation, sometimes severe can occur.


To be determined by Registrant

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

Minor

19. Provide supplemental information here

Potential Cause Kocide 2000 Fungicide (Canadian) Because the time course was totally consistent, the amount was generally consistent, and the findings were totally consistent, this substance was considered to have high likelihood of causing the clinical situation.