Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2657

2. Registrant Information.

Registrant Reference Number: 2012TH002

Registrant Name (Full Legal Name no abbreviations): Bayer Inc

Address: 77 Belfield Rd

City: Toronto

Prov / State: ON

Country: Canada

Postal Code: M9W 1G6

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

18-JAN-12

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

12-JAN-12

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. Unknown

Product Name: advantage

• Active Ingredient(s)
  • IMIDACLOPRID

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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: 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).

The owner does not know what size of product she used, she commented that the vet sold her advantage for dogs and told her to give 0.08. She didn't know units and said she only gave 4 bars of it on the syringe (0.4 ml?) It is unclear if it was from a newly opened tube or the tube she used the month previously.

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

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

unknown

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>1 mo <= 6 mos / > 1 mois < = 6 mois

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

• Skin
  • Symptom - Lesion

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

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

Owner contacted Bayer on Jan 18 2012 to report that she used advantage on her cats in December and one cat had a small sore at the application site. The owner was not concerned and attributed this to self trauma from scratching at fleas. The owner treated the cat again in Jan 12 and noticed a larger sore at the application site on Jan 14. The owner contacted us as the sore seemed to be getting worse and the cat was scratching at it. I asked the owner what size she used and she commented that the vet sold her advantage for dogs and told her to give 0.08. She didn't know units and said she only gave 4 bars of it on the syringe (0.4 ml?) It is unclear if it was from a newly opened tube or the tube she used the month previously.

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To be determined by Registrant

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

Minor

19. Provide supplemental information here