Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-6070
2. Registrant Information.
Registrant Reference Number: 199105
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.
15-JUN-07
5. Location of incident.
Country: UNITED STATES
Prov / State: ILLINOIS
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.
PMRA Submission No.
EPA Registration No. 721557
Product Name: Rose & Flower Insect Killer Ready to Spray
- Active Ingredient(s)
- CYFLUTHRIN
- Guarantee/concentration .36 %
- IMIDACLOPRID
- Guarantee/concentration .36 %
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
Cat / Chat
3. Breed
DSH
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
10
7. Weight (provide a range if necessary )
10
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
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Nervous and Muscular Systems
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 exposure witnessed. Exposure based on speculation.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Cat owner called to report that her cat fell ill about 12 hours after product was applied to some flower bushes outside the home on 6/7/2007. Cat was allowed to roam freely outside the home, but was never actually seen in the area where the product had been applied to the bushes, so it is unclear how or if the cat was exposed to the pesticide. Cat¿¿¿s initial symptoms consisted of vocalizing, muscle rigidity,and ataxia. Cat was finally taken to a vet hospital on 6/11/2007 due to ongoing symptoms. The DVM suspected some type of infectious cause and treated the cat with an antibiotic injection intramuscularly before the cat was sent home. The cat¿¿¿s symptoms subsided for one day, then returned again resulting in the cat¿¿¿s eventual death while at home.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here