Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2013-6676
2. Registrant Information.
Registrant Reference Number: 1238695
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.
02-SEP-13
5. Location of incident.
Country: UNITED STATES
Prov / State: NEW JERSEY
6. Date incident was first observed.
01-SEP-13
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. 72155-29
Product Name: Complete Insect Killer for Soil & Turf (Ready-to-Spray) 32 fl oz
- Active Ingredient(s)
- CYFLUTHRIN
- Guarantee/concentration .36 %
- IMIDACLOPRID
- Guarantee/concentration .72 %
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
Cat / Chat
3. Breed
Russian Blue
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
3
7. Weight (provide a range if necessary )
12.00
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
<=15 min / <=15 min
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Bloody stool
- Symptom - Foaming at mouth
- General
- Symptom - Death
- Symptom - Pale mucous membrane colour
- Nervous and Muscular Systems
- Gastrointestinal System
- Symptom - Rectal hemorrhage
- Specify - bleeding from the rectum
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 Exposure was not witnessed and is based on speculation.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
9/2/2013: Caller sprayed the exterior home foundation with the product about 24 hours ago (9/1/2013). About 1.5 hours ago the owner found his cat foaming at the mouth, unresponsive, white gums, and bleeding from the rectum. About 20 minutes later the cat died. The caller wanted to know if the product could be responsible. Caller does not know how the cat could have been exposed to the product. Caller is not aware of any other potential exposures. However, caller did state that his house is infested with fleas and he had to put a dog down earlier in the week due to a flea infestation. Caller stated the cat was also likely infested with fleas.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here