Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-2111

2. Registrant Information.

Registrant Reference Number: 2014-IR-01

Registrant Name (Full Legal Name no abbreviations): E.I. du Pont Canada Company

Address: 1919 Minnesota Court

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5M 2J4

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

Human

4. Date registrant was first informed of the incident.

06-JUN-14

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

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. 28981      PMRA Submission No.       EPA Registration No. 352-730

Product Name: Altacor

• Active Ingredient(s)
  • CHLORANTRANILIPROLE

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PMRA Registration No. 10868      PMRA Submission No.       EPA Registration No. 352-342

Product Name: Lannate

• Active Ingredient(s)
  • METHOMYL
    • Unknown

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7. b) Type of formulation.

Wettable or soluble powder

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.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Cancer

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Occupational

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.

Skin

Eye

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.)

In a complaint filed with the superior court of (city) County, the plaintiff, states that during the course of her employment in (state) from 1989 through 2012, her job responsibilities brought her into direct contact with numerous pesticide products. No specific pesticide or group of pesticides are alleged to cause the effects cited in the complaint, nor is there any information provided regarding how exposure may have occurred and the extent to which it could have occurred. Among the 100+ different pesticide products and pesticide active ingredients, those listed above were listed in the court filing. Plaintiff allege that exposure to various chemicals caused Acute Myelogenous Leukemia. As medical treatment, she has been hospitalized and undergone surgery and other treatments and will require organ transplantation as medically necessary and lifesaving treatment.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

No lab reports have been made availabel to DuPont.