Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2011-1861

2. Registrant Information.

Registrant Reference Number: 2011-IR-02

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.

27-APR-11

5. Location of incident.

Country: UNITED STATES

Prov / State: ARKANSAS

6. Date incident was first observed.

14-APR-11

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. 352-756

Product Name: DuPont Envive Herbicide

• Active Ingredient(s)
  • CHLORIMURON-ETHYL
    • Unknown
  • FLUMIOXAZIN
  • FOMESAFEN
    • Unknown
  • S-METOLACHLOR AND R-ENANTIOMER
    • Unknown
  • THIFENSULFURON METHYL
    • Unknown

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7. b) Type of formulation.

Liquid

Dry Flowable (water dispersible granules)

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Anorexia
  • Specify - no appetite

• General
  • Symptom - Death

• Respiratory System
  • Symptom - Pneumonia
  • Specify - "suspicious for multi-lobular pneumonia

• Renal System
  • Symptom - Renal failure

• General
  • Symptom - Other
  • Specify - hypovolemic shock

• Cardiovascular System
  • Symptom - Shock
  • Specify - low blood pressure

• General
  • Symptom - Pain
  • Specify - bad joint pain, body aches

• Nervous and Muscular Systems
  • Symptom - Difficulty walking
  • Specify - 'could barley walk'

• Respiratory System
  • Symptom - Shortness of breath
  • Specify - mild shortness of breath

• General
  • Symptom - Fever

4. How long did the symptoms last?

Persisted until death

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

2

Day(s) / Jour(s)

7. Exposure scenario

Occupational

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

Other

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

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

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

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.)

Person was loading the above mentioned product into a truck and some "blew back in his face". Five days later he went to a local ER and later transfered to Univ. of (name) Medical Centre. His symptoms are described as follows: " on Friday evening (April 8) he started feeling bad joint pain and mild shortness of breath. Upon admission to the ER (April 12) he was noted to have low blood pressure and placed on oxygen and intravenous fluids. The following day, it was reported that his symptoms had worsened, his blood pressure was still low, his heart rate was elevated and he appeared to be going into hypovolemic shock, and was now in renal failure and no longer breathing on his own (intubated). A radiologist's reading of the chest x-ray indicated the patient was "suspicious for multi-lobular pneumonia". On the afternnoon of April 13, he died.

To be determined by Registrant

14. Severity classification.

Death

15. Provide supplemental information here.

The cause(es) 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. The report to us indicates that medical professionals may also be testing for the presence of "paraquat" in the patients' blood samples. As of the date of this report, 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 Envive Herbicide.