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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-1060
2. Registrant Information.
Registrant Reference Number: 216418
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.
26-JUL-075. Location of incident.
Country: CANADA
Prov / State: SASKATCHEWAN
6. Date incident was first observed.
25-JUL-07Product 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. 18022 PMRA Submission No. EPA Registration No.
Product Name: Buctril M (Canada)
- Active Ingredient(s)
- BROMOXYNIL
- MCPA (PRESENT AS ESTERS)
7. b) Type of formulation.
Application Information
8. Product was applied?
No
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
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 )
8
7. Weight (provide a range if necessary )
Unknown
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
- General
- Symptom - Lethargy
- Respiratory System
- Symptom - Panting
- Symptom - Laboured breathing
12. How long did the symptoms last?
>3 days <=1 wk / >3 jours <=1 sem
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
Fully Recovered / Complètement rétabli
16. How was the animal exposed?
Other / Autre
specify Defined point of exposure not evident or witnessed. Exposure based on speculation.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
7/26/2007Caller reports that the dog was in a shed during the day yesterday where product was stored, and a container of product was found to have been chewed on. No exposure was witnessed. Dog was found to be panting and breathing heavily later that evening. Today dog is lethargic and has labored breathing. Owner has bathed dog. Immediate evaluation by DVM was recommended to caller. 8/2/2007Call back for follow up attempted. Line was busy, did not reach owner.8/8/2007Call back for follow up completed. Owner refused to take dog to DVM for evaluation. Dog began to show improvement four days later and symptoms resolved with no further treatment.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
