Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-5838

2. Registrant Information.

Registrant Reference Number: 2015-IR-10

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

Address: 1919 Minnesota Court

City: ON

Prov / State: Mississauga

Country: Canada

Postal Code: L5M 2J4

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

Domestic Animal

4. Date registrant was first informed of the incident.

16-SEP-15

5. Location of incident.

Country: UNITED STATES

Prov / State: UNKNOWN

6. Date incident was first observed.

30-AUG-15

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. 352-384

Product Name: Lannate LV Insecticide

• Active Ingredient(s)
  • METHOMYL
    • Unknown

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7. b) Type of formulation.

Liquid

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 III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Other / Autre

specify Deer

3. Breed

unknown

4. Number of animals affected

6

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Intentional poison./Empois. intentionnel

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

The dead animals were discovered by property owner on August 30. He reported the deer that day to the (name) County, (state) Sheriff s Department. Deputy sheriff was the responding deputy. Tenant farmer was interviewed by the sheriff, he Owns and operates (name) Produce. He reported that he had intentionally laced partially eaten squash with Lannate and then placed the squash on the deer trail to kill the deer. When told the authorities were coming to investigate, he threw the squash in a dumpster that was going to the landfill. A leaf sample from the squash production fields is in the custody of the (name) County Sheriff s Department. It does not appear the normal applications for which he uses Lannate are the issue, but rather the intentional lacing of the squash with undiluted Lannate LV. He provided the label and admitted he did poison the deer. Deer were damaging the squash crop. There are concerns about secondary kill as the area is heavily populated by Bald Eagles, but no secondary poisonings have been found to date. They will keep us informed should anything else arise. The Department of Ag investigator Conducted an onsite inspection on September 3rd about 11 AM. 4 deer carcasses hide only (fawns) 2 additional deer (adult) found in the tree lines hidden in a lot of heavy brush (4050% of the carcasses remained.

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To be determined by Registrant

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

Death

19. Provide supplemental information here