Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-7475

2. Registrant Information.

Registrant Reference Number: 1877964

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

Address: 160 QUARRY PARK BLVD. SE Suite 200

City: CALGARY

Prov / State: AB

Country: Canada

Postal Code: T2C 3G3

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

Domestic Animal

4. Date registrant was first informed of the incident.

02-AUG-16

5. Location of incident.

Country: UNITED STATES

Prov / State: MICHIGAN

6. Date incident was first observed.

01-AUG-16

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. 72155-29

Product Name: Complete Insect Killer for Soil & Turf (Ready-to-Spray) 32 fl oz

• Active Ingredient(s)
  • CYFLUTHRIN
    • Guarantee/concentration .36 %
  • IMIDACLOPRID
    • Guarantee/concentration .72 %

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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

Female

6. Age (provide a range if necessary )

1.50

7. Weight (provide a range if necessary )

5.00

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Anorexia
  • Symptom - Vomiting

• General
  • Symptom - Death
  • Symptom - Lethargy
  • Symptom - Vocalizing

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?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Ingesting grass that had been treated with product.

17. Provide any additional details about the incident

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

8/2/2016 Caller sprayed product on the grass 2 days ago. Caller let the product dry on the grass before the dog was allowed outside. The dog was seen ingesting the grass that day. The dog was normal until yesterday afternoon. The dog began acting lethargic and started vomiting repeatedly. The dog was unable to hold down food and water. The dog is moaning. Caller's mother attempted to give the dog water and food with a syringe, but the dog is not allowing this. The dog will not eat or drink today. Caller said the dog died during the call. Caller will not disconnect to take the dog to the veterinarian.

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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