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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-6045

2. Registrant Information.

Registrant Reference Number: 675180

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.

09-AUG-10

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW JERSEY

6. Date incident was first observed.

07-AUG-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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 72155-29

Product Name: Complete Insect Killer for Soil + Turf Concentrate 32 fl oz

  • Active Ingredient(s)
    • CYFLUTHRIN
      • Guarantee/concentration .36 %
    • IMIDACLOPRID
      • Guarantee/concentration .72 %

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. - 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?

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Basset Hound

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

54.00

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

Unknown / Inconnu

11. List all symptoms

System

  • Blood
    • Symptom - Bleeding
  • Cardiovascular System
    • Symptom - Cardiac arrest
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Melena
  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Recumbent
    • Symptom - Seizure

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?

1

Day(s) / Jour(s)

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

8/9/2010 Caller is a veterinarian treating a dog that presented collapsed today. The diluted product was applied to the owner's yard two days ago. Three dogs in the home were allowed onto the yard once the product was dry. The dog had significant diarrhea, melena, possible seizure, and then went into cardiac arrest. Cardiopulmonary resuscitation was performed. The dog arrested a second time, and a large pool of blood formed in the dogs mouth and from his anus. The dog died, and no necropsy was performed. The other two dogs on the property have remained healthy.


To be determined by Registrant

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

Death

19. Provide supplemental information here