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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-5738

2. Registrant Information.

Registrant Reference Number: 812282

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.

01-JUL-11

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW JERSEY

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. 72155-58

Product Name: Carpenter Ant + Termite Killer Plus Concentrate

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

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

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Labrador Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

100.00

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Death
  • Renal System
    • Symptom - Renal failure

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?

Other / Autre

specify No known point of exposure has been indentified. Exposure is speculative and unlikely since product applied outdoors and dog is an indoor pet.

17. Provide any additional details about the incident

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

7/1/2011 6:14:27 AM Caller reports that her dog died on the evening of 6/29. The dog died acutely. There were not any signs preceding her death that she noticed. This is an indoor dog. She is always supervised when she is outdoors. Gross necropsy has been performed, and nothing was found. Histopathology is planned Product was applied around the exterior perimeter of her home. The pesticide application was done approximately 1-2 weeks prior to the dog dying. The dog was never seen around the areas where the pesticide had been applied and the dog is primarily an indoor dog. Follow-up on 7/4/2011 Pathology report shows that the dog had kidney disease which is the likely cause of death. The necropsy report did not implicate the pesticide.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Any relationship between the use of this product and the delayed development of the complications reported in this case is inconceivable and lacks biological plausibility. Secondly, the product use history is extremely vague and lacks any description of a known or defined point of direct exposure to this product. Even had casual or incidental contact with a surface treated with this pesticide occurred, such kidney disease as reported in this dog is not consistent with the toxicology profile of a pyrethroid insecticide. Even if true pyrethroid toxicity were to occur in this case it would manifest with acute neurological complications, primarily in the form of tremors and ataxia which were not reported in this incident. Furthermore, the pathology report identified kidney disease as the cause of death and did not implicate this pesticide.