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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-1056

2. Registrant Information.

Registrant Reference Number: 1925569

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.

15-OCT-16

5. Location of incident.

Country: UNITED STATES

Prov / State: LOUISIANA

6. Date incident was first observed.

15-OCT-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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 432-1255

Product Name: MaxForce Granular Insect Bait 6 lb

  • Active Ingredient(s)
    • HYDRAMETHYLNON
      • Guarantee/concentration 1 %

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

Chihuahua

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

2.00

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

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Stiffness
  • Gastrointestinal System
    • Symptom - Inappropriate defecation
    • Symptom - Other
    • Specify - inappropriate urination
  • Skin
    • Symptom - Pale mucous membrane colour
    • Specify - foam mucous

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

10/15/2016 Caller had someone place product in their back and front yards today. She was unaware that this happened, and her dogs were left outside while she was gone today. She has cameras, and saw two of her dogs on camera eating the product this morning. Dog #1 was eating for about 5 minutes, and dog #2 was eating for about 2 minutes. Around 8 hours after exposure caller came home and found dog #1 dead on the living room floor. She was very stiff and had defecated, urinated, and had foam mucous all around her. The other dog seems okay, but is pawing at his face and rubbing his face on everything every 2 minutes. There was another product sprayed in the yard, but caller does not know what that product is. The dogs were off the yard for 90 to 120 minutes before entering, so caller thought it was dry. Caller is a veterinary technician at the clinic evaluating dog #2. The dog is asymptomatic upon exam. The clinic plans to hospitalize dog #2 on intravenous fluids for observation.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Boston Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1.50

7. Weight (provide a range if necessary )

12.00

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

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • General
    • Symptom - Abnormal grooming
    • Symptom - Abnormal behaviour
    • Specify - rubbing his face on everything every 2 minutes

12. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 h

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

Unknown/Inconnu

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

10/15/2016 Caller had someone place product in their back and front yards today. She was unaware that this happened, and her dogs were left outside while she was gone today. She has cameras, and saw two of her dogs on camera eating the product this morning. Dog #1 was eating for about 5 minutes, and dog #2 was eating for about 2 minutes. Around 8 hours after exposure caller came home and found dog #1 dead on the living room floor. She was very stiff and had defecated, urinated, and had foam mucous all around her. The other dog seems okay, but is pawing at his face and rubbing his face on everything every 2 minutes. There was another product sprayed in the yard, but caller does not know what that product is. The dogs were off the yard for 90 to 120 minutes before entering, so caller thought it was dry. Caller is a veterinary technician at the clinic evaluating dog #2. The dog is asymptomatic upon exam. The clinic plans to hospitalize dog #2 on intravenous fluids for observation.


To be determined by Registrant

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

Minor

19. Provide supplemental information here