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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5148

2. Registrant Information.

Registrant Reference Number: 536260

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.

21-SEP-09

5. Location of incident.

Country: UNITED STATES

Prov / State: LOUISIANA

6. Date incident was first observed.

18-SEP-09

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. 432-1483

Product Name: Temprid SC Insecticide

  • Active Ingredient(s)
    • CYFLUTHRIN
      • Guarantee/concentration 10.5 %
    • IMIDACLOPRID
      • Guarantee/concentration 21 %

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. - 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?

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Dog / Chien

3. Breed

Mixed Breed

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

105.00

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Coma
  • Respiratory System
    • Symptom - Rapid breathing

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?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Details of exposure remain unknown. It is speculated that the product may have accidentally drifted onto the dog's fur.

17. Provide any additional details about the incident

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

9/21/2009 11:10:33 AM The caller states that her dog was with the Pest Control Operator during product application on 9/18/09 (dilute product applied at 0.15% solution). There was no witnessed oral exposure however the product was noted on dog¿s coat. Within 30 minutes of application the dog was non-responsive, panting, and had his tongue hanging out. The dog was immediately presented to the veterinarian who bathed the dog in an unknown soap. An intravenous catheter was placed and intravenous fluids were administered. The caller is unsure if any medications were administered. The dog went into a coma and passed away on his own on 9/19/09.


To be determined by Registrant

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

Death

19. Provide supplemental information here