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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-0854

2. Registrant Information.

Registrant Reference Number: 800220

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.

07-JUN-11

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

07-JUN-11

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. 27564      PMRA Submission No.       EPA Registration No.

Product Name: PROSPER FL (Canada)

  • Active Ingredient(s)
    • CARBATHIIN
    • CLOTHIANIDIN
    • METALAXYL
    • THIRAM

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Other / Autre

Préciser le type: Canola Seed

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

Mixed Breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1.50

7. Weight (provide a range if necessary )

35.00

lbs

8. Route(s) of exposure

Oral

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 - Salivating excessively
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
  • Respiratory System
    • Symptom - Shortness of breath

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.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

12

Hour(s) / Heure(s)

15. Outcome of the incident

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

6/7/2011 Caller's dog ingested an unknown amount of canola seed that was pre-treated with the product three hours ago. The dog was found salivating and tremoring. The dog is at the veterinarian now with a family member. 6/8/2011 The treating veterinarian is calling. The dog was in respiratory distress on arrival. The dog has been given atropine and oxygen, and is responding. The dog also has minor tremoring. 6/10/2011 Attempted callback to the original caller for follow up information. There was no answer and no way to leave a message. 6/16/2011 Callback to the original caller for follow up information. The dog was kept overnight for 12 hours and treated with charcoal. The dog is doing well.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here