Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-6049

2. Registrant Information.

Registrant Reference Number: 682614

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.

24-AUG-10

5. Location of incident.

Country: UNITED STATES

Prov / State: WEST VIRGINIA

6. Date incident was first observed.

23-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. 72155-56

Product Name: 12 Month Tree + Shrub Insect Control Concentrate II

  • Active Ingredient(s)
    • IMIDACLOPRID
      • Guarantee/concentration 2.94 %

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: 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).

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?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Greyhound

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.31

7. Weight (provide a range if necessary )

24.00

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

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Bloody stool
    • Symptom - Vomiting
  • General
    • Symptom - Dehydration
    • Symptom - Lethargy

12. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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?

3

Day(s) / Jour(s)

15. Outcome of the incident

Fully Recovered / Complètement rétabli

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

8/24/2010 Caller is a veterinarian treating a dog that had 12 milliliters of concentrated product intentionally applied along the back by an employee at a breeding kennel. The dog is dehydrated, depressed, has bloody mucus in the stool, and has vomited while in the clinic. The dog has been given intravenous fluids. Fecal examination and packed cell volume are normal besides dehydration, and a parvovirus test is being performed. The product was applied to 9 dogs at the kennel. One of the dogs died last night, and the other 7 dogs are asymptomatic. None of the dogs have been bathed. This is the only dog that was brought to the veterinarian for evaluation. 8/28/2010 Callback attempted to the original caller for follow up information. There was no answer at the clinic and no way to leave a message. 8/31/2010 Callback attempted to the original caller. A message was left requesting follow up information. 9/2/2010 Original veterinarian calling back with follow-up. It has been determined that all dogs had contracted parvovirus. Six of the dogs lived, and three died. No complications reported related to the improper use of he pesticide on these dogs.


To be determined by Registrant

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

Major

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Greyhound

4. Number of animals affected

3

5. Sex

Male

6. Age (provide a range if necessary )

0.31

7. Weight (provide a range if necessary )

Unknown

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

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Death

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?

Treatment / Traitement

17. Provide any additional details about the incident

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

8/24/2010 Caller is a veterinarian treating a dog that had 12 milliliters of concentrated product intentionally applied along the back by an employee at a breeding kennel. The dog is dehydrated, depressed, has bloody mucus in the stool, and has vomited while in the clinic. The dog has been given intravenous fluids. Fecal examination and packed cell volume are normal besides dehydration, and a parvovirus test is being performed. The product was applied to 9 dogs at the kennel. One of the dogs died last night, and the other 7 dogs are asymptomatic. None of the dogs have been bathed. This is the only dog that was brought to the veterinarian for evaluation. 8/28/2010 Callback attempted to the original caller for follow up information. There was no answer at the clinic and no way to leave a message. 8/31/2010 Callback attempted to the original caller. A message was left requesting follow up information. 9/2/2010 Original veterinarian calling back with follow-up. It has been determined that all dogs had contracted parvovirus. Six of the dogs lived, and three died. No complications reported related to the improper use of he pesticide on these dogs.


To be determined by Registrant

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

Death

19. Provide supplemental information here