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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-6678

2. Registrant Information.

Registrant Reference Number: 1251540

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.

23-SEP-13

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW YORK

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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 432-992

Product Name: Drione

  • Active Ingredient(s)
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration 10 %
    • PYRETHRINS
      • Guarantee/concentration 1 %
    • SILICA AEROGEL
      • Guarantee/concentration 40 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Trimec 992 (non-registrant product)

  • Active Ingredient(s)
    • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
      • Unknown

7. b) Type of formulation.

Granular

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

Female

6. Age (provide a range if necessary )

13

7. Weight (provide a range if necessary )

38.00

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Death
    • Symptom - Lethargy
  • Respiratory System
    • Symptom - Shortness of breath
    • Symptom - Difficulty Breathing
    • Specify - erratic breathing
  • Gastrointestinal System
    • Symptom - Stomach pain
    • Specify - painful abdomen

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?

Yes

14. b) How long was the animal hospitalized?

1

Day(s) / Jour(s)

15. Outcome of the incident

Died

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

9/23/2013: Caller is wondering if an exposure to this product could have been the cause of her dog Haley's clinical signs and death. She reports that a company sprayed her outdoor concrete deck with this product around 4 pm local time on Wednesday 9/18/13, they also sprayed the lawn with Trimec 992 and used an "organic" pelleted product in the yard. Caller was not able to keep her 3 dogs off of the lawn for full rec time. On Thursday night, 9/19/13, Haley started having erratic breathing, vomiting, was not responding well, had a painful abdomen and was very weak. Haley was seen by a veterinarian and had radiographs. Veterinarian said there was a "swelling" in the abdomen (did not discuss if treatments were performed) and they scheduled an ultrasound for9/23/2013 to rule out a foreign body obstruction, pancreatitis, return of cancer, etc. but unfortunately Haley passed away last night. Caller is having a necropsy performed and will get the results today or tomorrow. Caller has also contacted the other product companies and was told the active ingredients in their products were not anticipated to cause these clinical signs. Follow-up on 10/28/2013: The results of the necropsy showed that the dog died of pancreatic cancer and a heart-line tumor. The pesticides had essentially been ruled out. It is also important to know that this dog had an anal tumor removed 7 months ago.


To be determined by Registrant

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

Death

19. Provide supplemental information here