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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-3698
2. Registrant Information.
Registrant Reference Number: 803873
Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.
Address: 295 Henderson Drive
City: Regina
Prov / State: SK
Country: Canada
Postal Code: S4N 6C2
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
14-JUN-115. Location of incident.
Country: UNITED STATES
Prov / State: TENNESSEE
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)PMRA Registration No. PMRA Submission No. EPA Registration No. 432-763
Product Name: Suspend SC
- Active Ingredient(s)
- DELTAMETHRIN
- Guarantee/concentration 4.75 %
- DELTAMETHRIN
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?
YesSubform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Domestic shorthair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
4
7. Weight (provide a range if necessary )
12.00
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>1 wk <=1 mo / > 1 sem < = 1 mois
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Anorexia
- General
- Symptom - Death
- Symptom - Fever
- Symptom - Lethargy
- Renal System
- Symptom - Urinary incontinence
- Respiratory System
- Symptom - Coughing
- Symptom - Cyanosis
- Symptom - Shortness of breath
- Symptom - Rapid breathing
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?
Unknown
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
6/14/2011 Product was applied to the baseboards in the kitchen two weeks ago, and caller's cats were not allowed in the area until product had dried. Ten days later, one cat became lethargic, incontinent, anorexic, developed a fever, rapid breathing, and coughing. The cat was taken to a veterinarian the next day. The cat was given a steroid injection, and x-rays were taken and blood work performed with normal results. The cat was sent home, but condition continued to worsen. The cat was brought back to the veterinarian two days ago. The cat was cyanotic on arrival, and was given oxygen, an antibiotic injection, and another unknown injection. The cat died at the clinic. It was believed that the cat had some type of infection. Today caller noticed the other cat in the home is coughing. 6/16/2011 Callback attempted to the original caller. A message was left requesting follow up information. 6/20/2011 Callback to the original caller for follow up information. The cat coughed for about 24 hours. The cat was taken to the veterinarian for evaluation. No treatments were performed.
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
Cat / Chat
3. Breed
Domestic shorthair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
9.00
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>1 wk <=1 mo / > 1 sem < = 1 mois
11. List all symptoms
System
- Respiratory System
- Symptom - Coughing
12. How long did the symptoms last?
>8 hrs <=24 hrs / > 8 h < = 24 h
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
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
6/14/2011 Product was applied to the baseboards in the kitchen two weeks ago, and caller's cats were not allowed in the area until product had dried. Ten days later, one cat became lethargic, incontinent, anorexic, developed a fever, rapid breathing, and coughing. The cat was taken to a veterinarian the next day. The cat was given a steroid injection, and x-rays were taken and blood work performed with normal results. The cat was sent home, but condition continued to worsen. The cat was brought back to the veterinarian two days ago. The cat was cyanotic on arrival, and was given oxygen, an antibiotic injection, and another unknown injection. The cat died at the clinic. It was believed that the cat had some type of infection. Today caller noticed the other cat in the home is coughing. 6/16/2011 Callback attempted to the original caller. A message was left requesting follow up information. 6/20/2011 Callback to the original caller for follow up information. The cat coughed for about 24 hours. The cat was taken to the veterinarian for evaluation. No treatments were performed.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
