Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-0885

2. Registrant Information.

Registrant Reference Number: 1486761

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.

20-OCT-14

5. Location of incident.

Country: UNITED STATES

Prov / State: WISCONSIN

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. Unknown

Product Name: SEVIN Brand (Non-specific)

• Active Ingredient(s)
  • CARBARYL
    • Unknown

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7. b) Type of formulation.

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

Mixed Breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

13

7. Weight (provide a range if necessary )

Unknown

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

• Gastrointestinal System
  • Symptom - Anorexia
  • Symptom - Salivating excessively

• General
  • Symptom - Death
  • Symptom - Lethargy

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?

No

14. b) How long was the animal hospitalized?

Unknown

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

10/20/2014 Caller is out of town, and caller's son is at home with their dog. The product was applied to the grass at the home yesterday. The dog was kept out of the treated area until today. The dog may have ingested dead bugs, but no exposure was witnessed. This afternoon the dog became lethargic, is drooling, and is not eating. 10/24/2014 Attempted call back to the original caller. A message was left requesting follow up information. 10/27/2014 Attempted call back to the original caller. A message was left requesting follow up information. Caller is returning the previous message. The product had nothing to do with the dog's symptoms. The dog was taken to the veterinarian, and found to be in late stages of liver cancer and estimated that organ systems were now failing. The dog also had a fever possibly due to an infection. Caller declined treatment other than an antibiotic for the fever. The dog died on 10/22/2014.

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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