Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-0114

2. Registrant Information.

Registrant Reference Number: 2013CK164

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.

26-NOV-13

5. Location of incident.

Country: CANADA

Prov / State: UNKNOWN

6. Date incident was first observed.

14-NOV-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)

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

Product Name: Advantage (unknown size)

• 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).

On 14-Nov-2013, a 14 year old, 5 pound, spayed, female, Domestic Shorthair feline, in unknown condition, with fleas, was administered 1 tube of Advantage (cat-unspecified) (Imidacloprid) once topically by the owner.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic short hair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

14

7. Weight (provide a range if necessary )

5

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

• Skin
  • Symptom - Hyperesthesia
  • Specify - skin twitching
  • Symptom - Pruritus

• Nervous and Muscular Systems
  • Symptom - Anxiety
  • Specify - exhited distress

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

Immediately post application the cat exhibited distress. The cat recovered later the same day and was overly affectionate to the owner (behavioral change).On 18-Nov-2013 the cat exhibited pruritus and skin twitching. No treatments or diagnostics were performed. The status of the cat is unknown.

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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

GDS comment: Distress may be a behavioural response to the product sensation/smell within this short time to onset. Generalized pruritus and skin twitching however are not anticipated with topical product administration. If any, skin reactions would be localized at the application site. Duration to onset time too long. Signs may be linked with other etiologies. Overall, a relation to the product is due to different signs and courses unclassifiable.