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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5049

2. Registrant Information.

Registrant Reference Number: 196370

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

Address: Suite 100, 3131 114 Avenue SE

City: Calgary

Prov / State: AB

Country: Canada

Postal Code: T2Z 3X2

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

Domestic Animal

4. Date registrant was first informed of the incident.

08-JUN-07

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

05-JUN-07

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. 26694      PMRA Submission No.       EPA Registration No.

Product Name: Liberty 150SN Herbicide

  • Active Ingredient(s)
    • GLUFOSINATE AMMONIUM

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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Unspecified

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?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Border Collie

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

14

7. Weight (provide a range if necessary )

60

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Anorexia
  • 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.

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Not recovered / Non rétabli

16. How was the animal exposed?

Other / Autre

specify No known point of exposure witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

June 8, 2007Caller reports that he diluted product according to label directions for ready-to-use application and applied product on his farm on 6/5/2007. On 6/6/2007 his dog fell ill with general lethargy and loss of appetite which continues to today. The caller is wondering if the herbicide may be responsible. There was no know exposure to the herbicide, but he speculates that the dog may have possible licked some diluted herbicide that had puddled on the ground.The caller was informed that the primary clinical effects expected if significant amounts of the diluted herbicide are ingested are vomiting and diarrhea. Given the absence of these symptoms, and the absence of defined point of known exposure, suggested that he investigate other causes. Also recommended that given the dog's age and the lingering illness, the dog should be seen by a DVM right away. Border Collies rarely do not live past 14 to 15 years of age.Follow-up completed on July 10, 2007Spoke with dog owner. She reports that the dog died on 6/10/2007. The dog was never taken in for an evaluation by a veterinarian.


To be determined by Registrant

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

Death

19. Provide supplemental information here