Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-1191

2. Registrant Information.

Registrant Reference Number: 702198

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.

06-OCT-10

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

Unknown

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.       PMRA Submission No.       EPA Registration No. 72155-58

Product Name: Carpenter Ant + Termite Killer Plus Concentrate

• Active Ingredient(s)
  • CYFLUTHRIN
    • Guarantee/concentration 2.5 %

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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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Yorkshire Terrier (Yorkie)

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Melena
  • 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.

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 Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

10/6/2010 Caller is a veterinarian calling from a clinic. A dog owner sprayed the product around the home 1.5 weeks ago. Two days ago, the dog developed vomiting and bloody diarrhea. The dog was not actually brought into the clinic, but another a veterinarian at the clinic had talk to the owner who had come in and sent the owner home with antibiotics. The dog died at home yesterday. Three other dogs in the home also developed bloody diarrhea and vomiting two days ago. None of the dogs had any witnessed exposure to the product. 10/15/2010 The original caller is calling back. Veterinarian suspects the dogs were suffering from a clostridial bacterial overgrowth based on a rapid response of the one treated dog to antibiotics. The pesticide involvement has been ruled out. Only one of the three surviving symptomatic dogs was brought to the clinic for treatment. The dog responded well to oral antibiotics, and was sent home the next day. The owner declined to bring the other two dogs in for treatment, and instead gave them Pepto Bismol at home. All three dogs have recovered and are now asymptomatic.

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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

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Unknown

4. Number of animals affected

3

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Melena
  • Symptom - Vomiting

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?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Other / Autre

specify Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

10/6/2010 Caller is a veterinarian calling from a clinic. A dog owner sprayed the product around the home 1.5 weeks ago. Two days ago, the dog developed vomiting and bloody diarrhea. The dog was not seen by a veterinarian at the clinic, but another veterinarian at the clinic did send the owner home with antibiotics for the dog. The dog died at home yesterday. Three other dogs in the home also developed bloody diarrhea and vomiting two days ago. None of the dogs had any witnessed exposure to the product. 10/15/2010 The original caller is calling back. Veterinarian suspects the dogs were suffering from a clostridial bacterial overgrowth based on a rapid response of the one treated dog to antibiotics. The pesticide involvement has been ruled out. Only one of the three surviving symptomatic dogs was brought to the clinic for treatment. The dog responded well to oral antibiotics, and was sent home the next day. The owner declined to bring the other two dogs in for treatment, and instead gave them Pepto Bismol at home. All three dogs have recovered and are now asymptomatic.

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To be determined by Registrant

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

Moderate

19. Provide supplemental information here