Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-3599

2. Registrant Information.

Registrant Reference Number: 1409123

Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.

Address: 295 Henderson Drive

City: Regina

Prov / State: SK

Country: Canada

Postal Code: S4N 6C2

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

Domestic Animal

4. Date registrant was first informed of the incident.

23-JUN-14

5. Location of incident.

Country: UNITED STATES

Prov / State: ALASKA

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. 72155-100

Product Name: DuraZone Weed and Grass Killer - Concentrate

• Active Ingredient(s)
  • DIQUAT
    • Guarantee/concentration .89 %
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
    • Guarantee/concentration 20.46 %
  • INDAZIFLAM

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

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

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Border Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

11

7. Weight (provide a range if necessary )

25.00

lbs

8. Route(s) of exposure

Unknown

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

• Nervous and Muscular Systems
  • Symptom - Seizure

• Respiratory System
  • Symptom - Shortness of breath

12. How long did the symptoms last?

Persisted until death

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

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

6/23/2014 Caller applied the product to the lawn outside of the fenced yard on 06/20/2014. The dog stays in the fenced yard, and does not go in the area of application. The dog was not outside during application or for about 2 hours after application. Caller states about 6 hours after she applied the product the dog started having seizures. By the time they arrived at the veterinarian, the dog was not coming out of the seizures. Dog was prescribed Phenobarbital. The dog is doing better but still on medication. 7/9/2014 Attempted call back to the original caller. A message was left requesting follow up information. 7/11/2014 Call back to the original caller. The dog died on 7/3/2014. The seizures were under control with Phenobarbital, but then the dog had another seizure and was taken back to the veterinarian. He began having troubles breathing and was intubated, but died on his own. Caller does not think it was due to the product.

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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