Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3404

2. Registrant Information.

Registrant Reference Number: 2010TH024

Registrant Name (Full Legal Name no abbreviations): Bayer Inc

Address: 77 Belfield Road

City: Toronto

Prov / State: ON

Country: Canada

Postal Code: M9W 1G6

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

26-JUL-10

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

24-JUL-10

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)

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PMRA Registration No. 25129      PMRA Submission No.       EPA Registration No.

Product Name: Advantage 18

• Active Ingredient(s)
  • IMIDACLOPRID

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

.8

Units: mL

10. Site pesticide was applied to (select all that apply).

Site: Animal / Usage sur un animal domestique

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?

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

11

7. Weight (provide a range if necessary )

5.4

kg

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>8 hrs <= 24 hrs / >8 h <= 24 h

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• General
  • Symptom - Death

• Cardiovascular System
  • Symptom - Cardiac arrest

• Eye
  • Symptom - Pupil dilation

• Respiratory System
  • Symptom - Respiratory failure

• Nervous and Muscular Systems
  • Symptom - Recumbent

• Blood
  • Symptom - Other
  • Specify - minor changes in red cell values, blood gases, glucose and creatinine

• General
  • Symptom - Hypothermia
  • Specify - temp 32C

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?

5

Hour(s) / Heure(s)

15. Outcome of the incident

Died

16. How was the animal exposed?

Treatment / Traitement

17. Provide any additional details about the incident

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

Owner applied product and presented pet to clinic approx 12-14 hours later, unable to walk, dilated pupils, temp 32 C. The clinic started IV fluids at a shock rate of 240 ml/kg/hr. Within 5 hours the cat developed respiratory failure and cardiac arrest. Blood work showed minor changes in red cell values, blood gases, glucose and creatinine.

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To be determined by Registrant

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

Death

19. Provide supplemental information here

A post-mortem was offered, the clinic has not yet advised as to whether one was performed. The attending veterinarian did not feel that this event was advantage related.