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: 2010-3975
2. Registrant Information.
Registrant Reference Number: 640831
Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.
Address: #200, 160 Quarry Park Blvd SE
City: Calgary
Prov / State: AB
Country: Canada
Postal Code: T2C 3G3
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
02-JUN-105. Location of incident.
Country: UNITED STATES
Prov / State: OKLAHOMA
6. Date incident was first observed.
29-MAY-10Product 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. 3125-506-72155
Product Name: Power Force Multi-Insect Granules 10 lb
- Active Ingredient(s)
- CYFLUTHRIN
- Guarantee/concentration .1 %
- CYFLUTHRIN
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?
YesSubform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Mixed Breed Labrador
4. Number of animals affected
4
5. Sex
Unknown
6. Age (provide a range if necessary )
0.15
7. Weight (provide a range if necessary )
10.00
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Diarrhea
- Symptom - Vomiting
- General
- Symptom - Death
12. How long did the symptoms last?
Persisted until death
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
Died
16. How was the animal exposed?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
June 2, 2010 Owner reports that a 6 month old puppy schnauzer mix as well as four lab mixes 8 weeks of age began to develop vomiting and diarrhea about 3 days ago. Today, the schnauzer mix has developed seizures. The insecticide had been applied around the perimeter of the home and unspecified period of time ago, and the owner speculates that the puppies may have ingested some of the granules off the ground. The owner was instructed to immediately take the puppies to an animal hospital. Follow-up on June 27, 2010. Owner states that they did not take the puppies to an animal hospital because they could not afford veterinary care. All 5 puppies died within 24 hours of the initial call. The owner states that the 6 month old schnauzer mix was a stray that they had recently taken in. None of the puppies had ever received preventative veterinary care.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Mixed Breed Schnauzer
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
0.5
7. Weight (provide a range if necessary )
20.00
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Diarrhea
- Symptom - Vomiting
- General
- Symptom - Death
- Nervous and Muscular Systems
- Symptom - Seizure
12. How long did the symptoms last?
Persisted until death
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
Died
16. How was the animal exposed?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
June 2, 2010 Owner reports that a 6 month old puppy schnauzer mix as well as four lab mixes 8 weeks of age began to develop vomiting and diarrhea about 3 days ago. Today, the schnauzer mix has developed seizures. The insecticide had been applied around the perimeter of the home and unspecified period of time ago, and the owner speculates that the puppies may have ingested some of the granules off the ground. The owner was instructed to immediately take the puppies to an animal hospital. Follow-up on June 27, 2010. Owner states that they did not take the puppies to an animal hospital because they could not afford veterinary care. All 5 puppies died within 24 hours of the initial call. The owner states that the 6 month old schnauzer mix was a stray that they had recently taken in. None of the puppies had ever received preventative veterinary care.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
