Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-2348
2. Registrant Information.
Registrant Reference Number: 2011-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.
23-MAY-11
5. Location of incident.
Country: UNITED STATES
Prov / State: KENTUCKY
6. Date incident was first observed.
28-MAR-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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 352-793
Product Name: Imprelis Herbicide
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
Yes
9. Application Rate.
3
Other Units: oz/acre
10. Site pesticide was applied to (select all that apply).
Site: Res. - Out Home / Rés - à l'ext.maison
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Product was applied by owner of (company name) Lawn Care. It was a home lawn that was sprayed. Small home lawn. Size of the lawn was not given.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Yes
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
unknown
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>2 mos <=6 mos / > 2 mois < = 6 mois
11. List all symptoms
System
- Cardiovascular System
- Symptom - Other
- Specify - unknown
12. How long did the symptoms last?
Persisted until death
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
Died
16. How was the animal exposed?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
The homeowner called Lawn Care Operator an unknown number of days after treatment to let him know their dog had died. The homeowner is accusing the LCO and the chemical used for cause of death. True cause of death is unknown. Owner of Go Green Lawn Care sprayed the homeowners lawn at 3 oz/acre. He notified the homeowner to keep pets off of applied area until spray had dried. He got a call an unspecified amount of time later indicating that the homeowners dog had died. True cause of death is unknown.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Alleged exposure occured on march 25, 2011. Dupont was notified of alleged incident on march 28, 2011. No other products were used on the lawn. The applicator is certified. The applicator was told that the lab tests were back on the dog and that "the dog had too much calcium in the body. Could have been from the chemical used on the lawn or could have been something else that killed the dog".