Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5088

2. Registrant Information.

Registrant Reference Number: 2010-IR-03

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.

Human

4. Date registrant was first informed of the incident.

12-OCT-10

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

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. 352-819

Product Name: DuPont Pastora Herbicide

• Active Ingredient(s)
  • METSULFURON-METHYL
    • Unknown
  • NICOSULFURON
    • Unknown

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7. b) Type of formulation.

Other (specify)

solid

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 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: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Other
  • Specify - Respiratory illness

• General
  • Symptom - Death

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Unknown

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

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.

Respiratory

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.)

An allegation that Mr. (name) was exposed (inhalation) to DuPont(tm) Pastora(r) Herbicide has been reported to DuPont from a secondhand source that did not appear to have direct knowledge of the alleged incident. The reliability of the information from this source is uncertain. Mr. (name) passed away a few weeks after the alleged inhalation exposure. The cause and onset of symptoms are unknown. We have not received any verification regarding the cause of death from any medical professional as of the date of this report.

To be determined by Registrant

14. Severity classification.

Death

15. Provide supplemental information here.

A "respiratory illness" according to what appears to be a second hand report of a conversation with attending physician. DuPont has not been contacted by a medical professional regarding this allegation; and no direct request has been made to DuPont in regards to toxicity information on DuPont(tm)Pastora(r) Herbicide. We also note that since no inhalation statement is required per EPA's Label Review Manual, the DuPont Pastora Herbicide MSDS states the following: "First Aid Measures: Inhalation Exposure. No specific intervention is indicated as the compound is not likely to be hazardous. Consult a physician if necessary.