Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2674

2. Registrant Information.

Registrant Reference Number: 2012TH020

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.

11-APR-12

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

07-APR-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. 25129      PMRA Submission No.       EPA Registration No.

Product Name: advantage 18

• Active Ingredient(s)
  • IMIDACLOPRID

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

.8

Units: mL

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).

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

Cat / Chat

3. Breed

Domestic short hair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

9.2

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• Skin
  • Symptom - Other
  • Specify - lump

• Gastrointestinal System
  • Symptom - Loss of appetite

• Eye
  • Symptom - Other
  • Specify - anisocoria

• Nervous and Muscular Systems
  • Symptom - Muscle twitching
  • Specify - whiskers twitching
  • Symptom - Head tilt

• Gastrointestinal System
  • Symptom - Drooling

12. How long did the symptoms last?

Unknown / Inconnu

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

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 applied product April 5. On April 7 the cat was presented to the clinic for a reduced appetite and a lump on his head. A sample was taken of the lump which seemed to be reactive cells, possibly a bug bite or wound from playing with puppy. The bladder was full and tense but emptied when squeezed. A slight tremble affected the whiskers on the right side was noted. The cat ate well during the exam. The cat was given 50 ml of NaCL SQ and sent home with canned food. The pet was re-examined April 9 and anisocoria was noted with the left pupil larger than the right. Whisker trembling still present, the owner also though they noticed a head tilt and drooling at home. Head trauma was the primary diagnosis and the cat was sent home for monitoring.

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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