Health Canada
www.hc-sc.gc.ca
Common menu bar links
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-0791
2. Registrant Information.
Registrant Reference Number: 318521
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.
12-MAY-085. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
07-MAY-08Product 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. 25673 PMRA Submission No. EPA Registration No.
Product Name: Tempo 20 WP
- Active Ingredient(s)
- CYFLUTHRIN
PMRA Registration No. PMRA Submission No. EPA Registration No.
Product Name: Demand CS
- Active Ingredient(s)
- LAMBDA-CYHALOTHRIN
PMRA Registration No. PMRA Submission No. EPA Registration No.
Product Name: Unspecified Granular Lawn Chemical
- Active Ingredient(s)
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. - In Home / Rés. - à l'int. 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?
YesSubform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
Soft Coated Wheaton Terrier
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
30
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
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Vomiting
- Nervous and Muscular Systems
- Symptom - Agitation
- Symptom - Confusion
- Respiratory System
- Symptom - Panting
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.
Yes
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
5/12/2008 Caller is a pest control officer, and reports that the products were applied in a building at a client's home and to the lawn on 5/8/08. The client's two dogs were not allowed in the areas of application for thirty hours, and had no known direct exposure to product. One dog developed lethargy, disorientation, and vomiting within twelve hours of re-entering the area. The second dog developed the same symptoms the following day. Both dogs were taken to the veterinarian for evaluation. The caller is unsure of what treatments were performed but knows the dogs were given IV fluids and an unspecified medication. No diagnosis was offered by the veterinarian. 5/20/2008 Caller is dog owner calling to update information. Caller reports that the first dog became anxious, vomited, panting, and arching its back twelve hours after re-entry. The second dog developed the same symptoms two hours later, but did not develop vomiting. The veterinarian gave the dogs something to coat their stomach and a prescription oral medication for three days.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
Soft Coated Wheaton Terrier
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
25
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
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Vomiting
- Nervous and Muscular Systems
- Symptom - Agitation
- Symptom - Confusion
- Respiratory System
- Symptom - Panting
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.
Yes
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
5/12/2008 Caller is a pest control officer, and reports that the products were applied in a building at a client's home and to the lawn on 5/8/08. The client's two dogs were not allowed in the areas of application for thirty hours, and had no known direct exposure to product. One dog developed lethargy, disorientation, and vomiting within twelve hours of re-entering the area. The second dog developed the same symptoms the following day. Both dogs were taken to the veterinarian for evaluation. The caller is unsure of what treatments were performed but knows the dogs were given IV fluids and an unspecified medication. No diagnosis was offered by the veterinarian. 5/20/2008 Caller is dog owner calling to update information. Caller reports that the first dog became anxious, vomited, panting, and arching its back twelve hours after re-entry. The second dog developed the same symptoms two hours later, but did not develop vomiting. The veterinarian gave the dogs something to coat their stomach and a prescription oral medication for three days.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
