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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-1550
2. Registrant Information.
Registrant Reference Number: 444269
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.
05-MAR-095. Location of incident.
Country: UNITED STATES
Prov / State: CALIFORNIA
6. Date incident was first observed.
Unknown
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. 432-836
Product Name: DeltaGard T+O Granular
- Active Ingredient(s)
- DELTAMETHRIN
- Guarantee/concentration .1 %
- DELTAMETHRIN
7. b) Type of formulation.
Granular
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?
Unknown
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
Male
6. Age (provide a range if necessary )
8
7. Weight (provide a range if necessary )
8.00
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Anorexia
- Skin
- Symptom - Burns (superficial)
- Specify - Oral Burns (incl lips)
12. How long did the symptoms last?
Unknown / Inconnu
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
Unknown/Inconnu
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
3/5/2009 Caller reports that the product was applied by a pest control officer on 1/27/09 and 2/10/09. Caller has cats that live outdoors in the areas where product was applied, but did not witness the cats having any direct exposure to the product. One cat was missing for two days, and then returned with ataxia and tongue ulcerations. The cat was hospitalized for two days on intravenous fluids, and died 10 days ago. A second cat developed oral ulcerations and ataxia 8 days ago. The second cat was taken to the veterinarian and given oral antibiotics. The cat's symptoms worsened, and the cat was taken to the veterinarian again yesterday. The cat was given an appetite stimulant and pain medication. The veterinarian has not given a diagnosis for either cat. The surviving cat has not been admitted to the veterinary hospital, just treated and sent home on both occasions. No necropsy was performed on the cat that had died.
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
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
DSH
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
14
7. Weight (provide a range if necessary )
8.00
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Skin
- Symptom - Burns (superficial)
- Specify - Oral Burns (incl lips)
- General
- Symptom - Death
- Nervous and Muscular Systems
- Symptom - Ataxia
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
Yes
14. b) How long was the animal hospitalized?
2
Day(s) / Jour(s)
15. Outcome of the incident
Died
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
3/5/2009 Caller reports that the product was applied by a pest control officer on 1/27/09 and 2/10/09. Caller has cats that live outdoors in the areas where product was applied, but did not witness the cats having any direct exposure to the product. One cat was missing for two days, and then returned with ataxia and tongue ulcerations. The cat was hospitalized for two days on intravenous fluids, and died 10 days ago. A second cat developed oral ulcerations and ataxia 8 days ago. The second cat was taken to the veterinarian and given oral antibiotics. The cat's symptoms worsened, and the cat was taken to the veterinarian again yesterday. The cat was given an appetite stimulant and pain medication. The veterinarian has not given a diagnosis for either cat. The surviving cat has not been admitted to the veterinary hospital, just treated and sent home on both occasions. No necropsy was performed on the cat that had died.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
