Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3446

2. Registrant Information.

Registrant Reference Number: 973793

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-MAY-12

5. Location of incident.

Country: UNITED STATES

Prov / State: UTAH

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 72155-86

Product Name: All in one lawn, weed and crabgrass killer

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
    • Guarantee/concentration 4.85 %
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
    • Guarantee/concentration .45 %
  • QUINCLORAC
    • Guarantee/concentration 1.61 %

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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

Mixed Breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1.50

7. Weight (provide a range if necessary )

6.00

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

• Gastrointestinal System
  • Symptom - Anorexia
  • Symptom - Bloody stool
  • Symptom - Vomiting

• General
  • Symptom - Death
  • Symptom - Lethargy
  • Symptom - Vocalizing

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?

No

14. b) How long was the animal hospitalized?

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

5/14/2012 Caller sprayed weeds in the yard 3 days ago using product diluted in water. Caller's dog was in the area after application and caller washed dog's paws, but no direct exposure was witnessed. Yesterday the dog was in the yard, but again no direct exposure was witnessed. Early this morning, dog developed vomiting, lethargy, anorexia, and vocalizing. 5/15/2012 Caller's dog developed bloody stool after the initial call. The dog was taken to a veterinarian for evaluation. The dog was started on Amoxicillin and Diawin, and caller was advised to monitor the dog at home on antibiotics. The dog was diagnosed with enteritis, however, the DVM did not offer a cause for the enteritis. The dog was vocalizing at home, and caller gave dog Tramadol that was prescribed for caller's other dog. She was told it was OK to give to the sick dog by her veterinarian. Tramadol did not seem to help with the vocalizing. The dog was crated overnight. Caller checked on the dog at 2 in the morning and he was resting comfortably and breathing normally. Caller found at 5 AM in the morning that dog had died. No necropsy will be performed.

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To be determined by Registrant

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

Death

19. Provide supplemental information here